Fordyce spots (also termed Fordyce granules or Fordyce disease) are visible sebaceous glands that are present in most individuals. They appear on the genitals 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 lips 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, unless the individual has cosmetic concerns. Persons with this condition sometimes consult a dermatologist because they are worried they may have a sexually transmitted disease (especially genital warts) or some form of cancer.
Sebaceous glands are normal adnexal structures of the dermis but may also be found ectopically within the mouth, where they are referred to as Oral Fordyce Granules or ectopic sebaceous glands. On the foreskin they are called Tyson's glands, not to be confused with hirsuties coronae glandis.
When they appear on the penis, they are also called penile sebaceous glands.
Signs and symptoms
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 (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. The distinction may be moot because both entities have the same treatment, although the adenoma has a greater growth potential. Sebaceous carcinoma 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.
Normally, sebaceous glands are only found in association with a hair follicle.
They appear to be more obvious in people with greasy skin types, with some rheumatic disorders, and in Hereditary nonpolyposis colorectal cancer. In the latter, the most common site for Fordyce spots is the lower gingiva (gums) and vestibular mucosa.
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 or dermoid cyst with sebaceous adnexa. The pathologist must be careful to differentiate such lesions from salivary neoplasms with sebaceous cells, such as sebaceous lymphadenoma and sebaceous adenoma, and their malignant counterparts sebaceous lymphadenocarcinoma and sebaceous carcinoma.
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. The surrounding stroma may contain occasional chronic inflammatory cells because of trauma with adjacent teeth.
Fordyce spots are completely benign and require no treatment. Often their presence is considered normal anatomic variance rather than a true medical condition.
Many people with Fordyce spots suffer in silence, especially young people, because they do not know what these spots are and feel embarrassed by them, especially for others to see.
Vaporising laser treatments such as CO2 laser or electro desiccation have been used with some success in diminishing the appearance of this condition if they are of cosmetic concern, despite the fact that most doctors consider this a normal physiological phenomenon and advise against treatment.
Success varies per patient, but some have found relief from pulsed dye lasers, a laser normally used to treat sebaceous gland hyperplasia, which is similar to Fordyce spots. Treatment with pulsed dye lasers is expensive, but may be less likely to scar than other methods.
A surgical treatment using a Micro-punch technique has shown to be an effective method that achieved very satisfactory functional and cosmetic results in patient that have multiple and/or very prominent fordyce spots.
No treatment is required for oral Fordyce granules, except for cosmetic removal of labial lesions if the individual wishes it. Inflamed glands can be treated topically with clindamycin. When surgically excised they will not recur. Neoplastic transformation is very rare but has been reported.
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.
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