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Sebaceous gland ectopia

OVERVIEW

What is Fordyce's disease?

Fordyce's disease, also known as sebaceous gland ectopia, is a condition caused by the variation and hyperplasia of sebaceous glands. Its exact cause is unknown but may be related to endocrine stimulation during puberty. The main manifestation is small, yellowish-white papules the size of a pinhead, without obvious elevation, appearing in clustered distributions. Lesions commonly occur on the oral mucosa and lips but may also be found on the penis, glans, foreskin, and labia.

This condition usually does not cause discomfort such as pain or itching and generally does not become malignant, so treatment is typically unnecessary [1].

For patients who require treatment, doctors may recommend physical therapy, radiation therapy, or surgical treatment. Most cases respond well, with only a few patients experiencing residual scarring or recurrence.

Is Fordyce's disease common?

Yes [1]. However, there is currently no precise epidemiological data available.

SYMPTOMS

What are the manifestations of Fordyce spots?

The typical characteristics of Fordyce spots are isolated, slightly raised small papules, yellowish-white in color and the size of a pinhead. They commonly appear on the oral mucosa and lips, and may also be found on the penis, glans, and foreskin in males, or the labia majora and minora in females.

Most patients experience no symptoms, with only a few reporting mild localized itching or a burning sensation [2].

CAUSES

What are the causes of Fordyce spots?

The exact cause of Fordyce spots remains unclear, but they are generally believed to be related to endocrine stimulation during puberty [1].

What are the predisposing factors for Fordyce spots?

  1. External irritation or trauma: External stimuli or injuries, such as accidentally swallowing fish bones, may trigger Fordyce spots.
  2. Smoking: Smoking is also considered a related factor, possibly because smokers are more prone to lip mucosal lesions [1,2].

Which groups are more susceptible to Fordyce spots?

  1. Males: According to clinical statistics, Fordyce spots are more common in males than in females [1].
  2. Adolescents: The condition typically appears around puberty (ages 10–20) [3], gradually increases in number, and stabilizes in adulthood [1].

DIAGNOSIS

When should someone with Fordyce spots seek medical attention?

  1. If the patient feels the papules affect their appearance or daily life, they can visit a dermatologist.
  2. If the papules appear around the genital area, prompt medical attention is necessary to determine whether the lesions are caused by Fordyce spots or a sexually transmitted disease (e.g., genital warts), and whether treatment is required.

What tests are needed for Fordyce spots?

Doctors can usually diagnose the condition through visual examination based on the location and characteristics of the lesions. Fordyce spots commonly appear on the lips and oral mucosa but may also occur around the genital area, presenting as isolated, slightly raised, yellowish-white papules the size of a pinhead.

If the rash is atypical and visual examination alone cannot confirm the diagnosis, a histopathological examination may be required. This involves removing a small piece of the affected tissue for biopsy. The diagnosis is confirmed if the tissue shows histopathological features of Fordyce spots (primarily small, mature sebaceous gland lobules surrounding sebaceous ducts) [4].

What conditions might be confused with Fordyce spots?

Genital warts: Caused by human papillomavirus (HPV) infection, genital warts are a sexually transmitted disease. Both Fordyce spots and genital warts can cause rashes around the genital area. Fordyce spots appear as yellowish-white, pinhead-sized papules, while early-stage genital warts present as single or clustered soft, pale red bumps with slightly pointed tips. Over time, they may multiply, enlarge, and take on shapes resembling papillomas, cauliflower-like growths, or cockscombs, with colors ranging from white to pink or dirty gray.

TREATMENT

Which department should I visit for Fordyce spots?

Dermatology or Dermatovenereology.

How to treat Fordyce spots?

Fordyce spots usually do not cause discomfort such as pain or itching, so treatment is generally unnecessary.

For patients who do require treatment, doctors may recommend physical therapy, radiation therapy, or surgical treatment [1,2].

  1. Physical Therapy:

    • Electrocoagulation: Uses high-frequency current to induce coagulative necrosis in the affected tissue, suitable for small and few papules.
    • Laser Therapy: CO2 laser can be used to remove the affected tissue, suitable for small-diameter papules.
    • Cryotherapy: Uses liquid nitrogen to rapidly freeze and necrotize the affected tissue, suitable for most types of Fordyce spot lesions.

  2. Radiation Therapy
    Isotope therapy: Uses isotopes such as strontium-90 patches applied to the affected area for about 1 week. The beta-rays released by the isotopes destroy the sebaceous gland structure, achieving therapeutic effects.

  3. Surgical Treatment
    Endoscopic resection: Mainly used for esophageal Fordyce spots. If the lesion is large or causes symptoms like sore throat or difficulty swallowing, the affected tissue can be removed under endoscopic guidance.

Can Fordyce spots be cured?

Fordyce spots generally do not require treatment. Most treated patients achieve good results, though a few may experience residual scarring or recurrence [1].

DIET & LIFESTYLE

What should patients with Fordyce spots pay attention to in daily life?

  1. If the patient has undergone treatments such as electrocoagulation, cryotherapy, laser therapy, or surgery, postoperative care should include keeping the skin clean and using mild, non-irritating skincare products (free of alcohol, fragrances, or other ingredients that may cause skin irritation) to avoid irritating the surgical wound and preventing infection.

  2. If abnormal conditions such as redness, swelling, or bleeding occur at the wound site, seek medical attention promptly.

What dietary precautions should patients with Fordyce spots take?

There are generally no specific dietary restrictions for patients with this condition. Maintaining a balanced diet with a mix of meat and vegetables is sufficient. However, it is advisable to avoid irritating foods (such as spicy foods) to prevent skin irritation and inflammation.

PREVENTION

Can Fordyce Spots Be Prevented? How to Prevent Fordyce Spots?

Since the exact cause of Fordyce spots remains unclear, there are no definitive measures to prevent their occurrence. However, avoiding potential triggers may help reduce the risk. For example:

  1. Avoid trauma or irritation to the skin or mucous membranes, such as preventing lip abrasions from falls or accidental swallowing of fish bones that may scratch oral mucosa or the esophagus;
  2. Quit smoking;
  3. Maintain a healthy lifestyle (regular routine, early sleep and wake-up, active exercise, balanced diet) and mental state to prevent endocrine imbalances that may increase susceptibility.