Fordyce spots (also termed Fordyce granules)
[James, William; Berger, Timothy; Elston, Dirk (2005). ''Andrews' Diseases of the Skin: Clinical Dermatology''. (10th ed.). Saunders. .] are visible
sebaceous glands that are present in most individuals. They appear on the
genitals
A sex organ (or reproductive organ) is any part of an animal or plant that is involved in sexual reproduction. The reproductive organs together constitute the reproductive system. In animals, the testis in the male, and the ovary in the female, a ...
and/or on the face and in the mouth. They appear as small, painless, raised, pale, red or white spots or bumps 1 to 3 mm in diameter that may appear on the scrotum, shaft of the
penis or on the
labia, as well as the inner surface (retromolar mucosa) and
vermilion border of the
lip
The lips are the visible body part at the mouth of many animals, including humans. Lips are soft, movable, and serve as the opening for food intake and in the articulation of sound and speech. Human lips are a tactile sensory organ, and can be ...
s of the
face. They are not associated with any disease or illness, nor are they infectious but rather they represent a natural occurrence on the body. No treatment is therefore required. Persons with this condition sometimes consult a dermatologist because they are worried they may have a
sexually transmitted disease
Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and oral s ...
(especially
genital warts
Genital warts are a sexually transmitted infection caused by certain types of human papillomavirus (HPV). They are generally pink in color and project out from the surface of the skin. Usually they cause few symptoms, but can occasionally be pai ...
) or some form of
cancer.
[Palo Alto Medical Foundation]
Bettina McAdoo, M.D. Retrieved June 24, 2006.
Some diseases may appear similar to Fordyce spots such as sexually transmitted diseases.
Description
On the shaft of the penis, Fordyce spots are more visible when the skin is stretched, and may only be noticeable during an erection.
The spots can also appear on the skin of the scrotum.
Oral Fordyce granules appear as rice-like granules, white or yellow-white in color. They are painless papules (small bumps), about 1–3 mm in greatest dimension. The most common site is along the line between the
vermilion border and the
oral mucosa of the upper lip, or on the
buccal mucosa
The oral mucosa is the mucous membrane lining the inside of the mouth. It comprises stratified squamous epithelium, termed "oral epithelium", and an underlying connective tissue termed ''lamina propria''. The oral cavity has sometimes been describ ...
(inside the cheeks) in the commissural region,
often bilaterally. They may also occur on the mandibular retromolar pad and tonsillar areas, but any oral surface may be involved. There is no surrounding mucosal change. Some patients will have hundreds of granules while most have only one or two.
Occasionally, several adjacent glands will coalesce into a larger cauliflower-like cluster similar to
sebaceous hyperplasia of the skin. In such an instance, it may be difficult to determine whether or not to diagnose the lesion as
sebaceous hyperplasia or
sebaceous adenoma
A sebaceous adenoma, a type of adenoma, a cutaneous condition characterized by a slow-growing tumor usually presenting as a pink, flesh-coloured, or yellow papule or nodule. James et al. 2006 Rapini et al. 2007
Significance
Sebaceous adenomas, i ...
. The distinction may be moot because both entities have the same treatment, although the adenoma has a greater growth potential.
Sebaceous carcinoma Sebaceous carcinoma, also known as sebaceous gland carcinoma (SGc), sebaceous cell carcinoma, and meibomian gland carcinoma is an uncommon malignant cutaneous tumor. Most are typically about 1.4 cm at presentation. SGc originates from sebace ...
of the oral cavity has been reported, presumably arising from Fordyce granules or hyperplastic foci of sebaceous glands.
In some persons with Fordyce spots, the glands express a thick, chalky discharge when squeezed.
Causes
Normally, sebaceous glands are only found in association with a
hair follicle
The hair follicle is an organ found in mammalian skin. It resides in the dermal layer of the skin and is made up of 20 different cell types, each with distinct functions. The hair follicle regulates hair growth via a complex interaction between h ...
.
They appear to be more obvious in people with oily skin types, with some
rheumatic disorders, and in
hereditary nonpolyposis colorectal cancer
Hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch syndrome is an autosomal dominant genetic condition that is associated with a high risk of colon cancer as well as other cancers including endometrial cancer (second most common), ovary, ...
.
In the latter, the most common site for Fordyce spots is the lower
gingiva (gums) and vestibular mucosa.
Diagnosis
Large numbers of lobules coalescing into a definitely elevated mass may be called benign sebaceous hyperplasia, and occasional small keratin-filled pseudocysts may be seen and must be differentiated from
epidermoid cyst
An epidermoid cyst or epidermal inclusion cyst is a benign cyst usually found on the skin. The cyst develops out of ectodermal tissue. Histologically, it is made of a thin layer of squamous epithelium.
Signs and symptoms
The epidermoid cyst may ...
or
dermoid cyst
A dermoid cyst is a teratoma of a cystic nature that contains an array of developmentally mature, solid tissues. It frequently consists of skin, hair follicles, and sweat glands, while other commonly found components include clumps of long hair ...
with sebaceous adnexa. The pathologist must be careful to differentiate such lesions from salivary neoplasms with sebaceous cells, such as
sebaceous lymphadenoma
Sebaceous lymphadenoma is a benign tumour of the salivary gland.
Diagnosis
Sebaceous lymphadenoma is a tissue diagnosis, e.g. salivary gland biopsy.
It may be confused with a number of benign and malignant neoplasms, including Warthin tumour, mu ...
and
sebaceous carcinoma Sebaceous carcinoma, also known as sebaceous gland carcinoma (SGc), sebaceous cell carcinoma, and meibomian gland carcinoma is an uncommon malignant cutaneous tumor. Most are typically about 1.4 cm at presentation. SGc originates from sebace ...
.
Oral Fordyce granules are usually not biopsied because they are readily diagnosed clinically, but they are often seen as incidental findings of mucosal biopsies of the buccal, labial and retromolar mucosa. The granules are similar to normal sebaceous glands of the skin but lack hair follicles and almost always lack a ductal communication with the surface. The glands are located just beneath the overlying epithelium and often produce a local elevation of the epithelium. Individual sebaceous cells are large, with central dark nuclei and abundant foamy
cytoplasm
In cell biology, the cytoplasm is all of the material within a eukaryotic cell, enclosed by the cell membrane, except for the cell nucleus. The material inside the nucleus and contained within the nuclear membrane is termed the nucleoplasm. Th ...
.
Classification
Sebaceous glands are normal structures of the
skin but may also be found
ectopically in the
mouth, where they are referred to as ''oral Fordyce granules'' or ectopic sebaceous glands.
On the
foreskin they are called
Tyson's gland Preputial glands are exocrine glands that are located in the folds of skin front of the genitals of some mammals. They occur in several species, including mice, ferrets, rhinoceroses, and even-toed ungulates and produce pheromones. The glands play ...
s,
not to be confused with
hirsuties coronae glandis
Pearly penile papules (PPP) are benign small bumps on the human penis. They vary in size from 1–4 mm, are pearly or flesh-colored, smooth and dome-topped or filiform, and appear in one or several rows around the corona, the ridge of the ...
.
When they appear on the penis, they are also called ''penile sebaceous glands''.
Treatment
Most doctors consider this a normal
physiological
Physiology (; ) is the scientific study of functions and mechanisms in a living system. As a sub-discipline of biology, physiology focuses on how organisms, organ systems, individual organs, cells, and biomolecules carry out the chemical ...
phenomenon and advise against treatment.
Prognosis
Fordyce spots are completely benign
and require no treatment. They occur in 70 to 80 percent of adults. Often their presence is considered normal anatomic variance rather than a true medical condition.
Epidemiology
This variation of normal anatomy is seen in the majority of adults. It is estimated about 80% of people have oral Fordyce spots,
but seldom are granules found in large numbers. They are not usually visible in children, and tend to appear at about age 3, then increasing during puberty and become more obvious in later adulthood.
They are more prominent in males.
History
They are named after an
American
American(s) may refer to:
* American, something of, from, or related to the United States of America, commonly known as the "United States" or "America"
** Americans, citizens and nationals of the United States of America
** American ancestry, pe ...
dermatologist,
John Addison Fordyce
John Addison Fordyce (born 16 February 1858 in Guernsey County, Ohio, died on 4 June 1925 in New York City) was an American dermatologist, whose name is associated with Fordyce's spot (also known as Fordyce's disease or Fordyce's lesion), Angioker ...
.
[Fordyce first described this condition in 1896.]
References
External links
DermAtlas: Fordyce spotsFordyce spots
{{Oral pathology
Penis
Conditions of the mucous membranes
Dermal and subcutaneous growths
Oral mucosal pathology
Vulva