Fordyce Spots

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Fordyce Spots Lips
Fordyce Spots Lips

What are Fordyce spots?

Fordyce spots, also known as Fordyce granules owing to their grain-like appearance, or sebaceous prominence, are a special set of sebaceous glands. The sebaceous glands are tiny tissue structures just beneath the skin that secrete a substance called sebum into hair follicles. Located all over the skin, except for the palms of the hands and the soles of the feet, they predominate in the scalp and the face. They are classed as exocrine glands, which is to say they transport their products directly to the surface of tissue rather than into the bloodstream like endocrine glands. Sebum is a fatty or oily substance such as ear wax or the microscopically thin layer called the acid mantle that entirely covers the skin to protect it from infection. It is vital in waterproofing skin and hair, maintaining its structural integrity and regulating body temperature in the form of perspiration. It is manufactured within the sebaceous cells via the holocrine process, whereby the mature cell’s enclosing plasma membrane bursts and releases the sebum to the outer epithelial layer (the surface of the affected tissue) through a duct. The remnants of the damaged cell are transported along with the sebum.

Fordyce spots
Fordyce spots

Fordyce spots are different in that they are clearly visible to the naked eye, measuring from about one to three centimetres in diameter, appearing ectopically (that is, misplaced) on the surface of the skin. These papules resemble goose bumps or grains of rice and are typically skin-coloured,pale red, white, or yellowish-white ‘milk spots’ (milia). Sometimes they come together in clusters that look very similar to sebaceous carcinomas, and it can be difficult to distinguish one from the other in a medical diagnosis. They are seen on both male and female genitalia or inside and around the mouth.

Oral Fordyce spots occur in an estimated eighty per cent of adults, but the spots do not generally cluster in great numbers. But it is not uncommon for them to form hundreds of clusters. General spots occur more commonly in males but are not so often seen in children before the age of three.

While Fordyce spots may appear alarming they have no connection whatsoever with sexually transmitted infections, cancers or any other illnesses. They cause no discomfort or irritation and are nothing to worry about health-wise. In fact they are widely considered to be a normal physical variation rather than a deformation. However it is possible to get treatment from a dermatologist if the cosmetic effect is of concern.

Causes of Fordyce spots

Fordyce spots are believed to be a symptom of the secretion of sebum. A normal sebaceous gland is associated with a hair follicle, and its discharged sebum is injected into the shaft of the hair, lubricating it. But when an ectopic sebaceous gland discharges, the sebum has nowhere to go except the skin; and this causes the formation of a Fordyce spot. Unlike pimples, which result from inflammation that flares up as a result of bacteria blocking hair follicles, Fordyce spots contain no pus and are neither painful nor contagious. While it is possible to develop sebaceous prominence at any age it is clear that puberty is a prime time for their appearance, as is old age. Greasy skin types are susceptible to the condition, and it is associated with some rheumatic disorders and hereditary nonpolyposis colorectal cancers, but there is no epidemiological evidence that there is a causal link. It is a common belief that stress can be a cause, but again there is no evidence to support this view. Malignant sebaceous tumours can occur in the oral cavity, and there is a theory that these are caused by Fordyce spots

Fordyce spots on lips

Fordyce spots on lips are located between the vermilion border, the edge of the mouth that separates it from the surrounding facial tissue, and the upper lip’s oral mucosa: the mucous lining on its inner surface. They can also form on the buccal mucosa, which lines the inside of the cheeks. There is a likeness to herpes spots in some cases, where the spots show as a white line, white patches or yellow dots (usually the result of mild but harmless inflammation or damage) but a medical examination can eliminate the latter as a cause. There is currently no universally agreed treatment for sebaceous prominence on the lips, and dermatologists tend to discourage attempts to cure it since Fordyce spots will eventually disappear naturally. Nevertheless spots can be reduced in visibility or got rid of altogether. This principle applies to all Fordyce spot treatment.

Fordyce Spots Lips
Fordyce Spots Lips

Penile papules

In the case of the male genitalia Fordyce spots manifest themselves on the shaft of the penis, the glans or scrotum and may only be visible when the skin is stretched or the penis is erect. Papules may be red or purple and form in clusters of about fifty to one hundred. They are caused by thickening of the skin around excessively dilated blood vessels. While they are nothing to worry about it is possible for them to bleed during sexual intercourse, which of course has implications for sexual health.

Pearly Penile Papules
Pearly Penile Papules

Fordyce spot treatments

There are quite a few methods of Fordyce spot treatment, including natural remedies and cures. While sebaceous prominence resolves itself with time it is possible to accelerate the fordyce spot cure process if this is desired.

Cryosurgery:

uses the very cold temperatures generated by liquid nitrogen to destroy papules, but it may also damage surrounding tissue and nerve endings. Additionally it has a rather low success rate.

Micro-punch technique:

known alternatively as punch excision, it is easy to carry out and less expensive than other treatments, but it can take anything from half an hour to several hours under local anaesthesia. It can also leave some scarring, but on the other hand recurrence is rare. This technique involves the use of a pen-like tool to target and remove the spots through a micro-incision, and stitching the incision together after excision of the spots.

Cauterisation:

an electro-surgical technique. A device called a hyfrecator (high-frequency eradicator), a low-power electrical appliance that sends high-frequency, high-voltage electrical pulses to the affected patch of skin, burns the spot out. A topical anaesthetic cream is applied beforehand to numb the skin. This is probably the principal technique used by dermatologists and is certainly the least costly. But there is a possibility of scarring, and the treated skin may take quite some time to heal.

Tretinoin gel:

a topical gel or cream that reduces the prominence of spots on the lips. Application with an exfoliating alpha-hydroxy-acid agent will enhance results.

Trichloroacetic chemical peel:

removes skin from papules, reducing their visibility. It is important to moisturise often. The condition may reappear after treatment.

Natural Remedies for Fordyce Spots:

Coconut oil, tea tree oil, vitamin supplements, oatmeal baths, garlic, turmeric, jojoba oil, asparagus, aloe vera gel, honey, lemon, camomile, comfrey, vanilla and sugar scrub and drinking plenty of water are all recommended natural treatments.

Fordyce spots laser removal

Fordyce spots laser removal can be effected with any one of the following techniques.

Pulsed Dye Lasers (PDL) are a leading method of Fordyce spots laser treatment. While this approach can be expensive it leaves less scarring than alternative therapies. PDL uses a concentrated beam of heated yellow light to affect the papules without destroying them or damaging surrounding nerves or skin. The blood vessels that feed the spot its nutrients are vapourised with the beam, starving it to death. A cold spray is used instead of anaesthetic, meaning that the treatment can be given in one short outpatient session. No skin damage, no pain, hardly any time – this is the leading edge of Fordyce spots laser treatment.

Electro-desiccation: carbon dioxide laser treatment, also called electro-desiccation, reduces the appearance of Fordyce spots. Carbon dioxide lasers are highly efficient tools, using a continuous wave of infra-red light to vapourise papules, resurfacing the affected skin. It is the best method of removing soft tissue currently in use compared to laser treatments using other wavelengths. Advantages are reduced surgery time, less chance of bleeding or infection, and little likelihood of post-op inflammation.

1 COMMENT

  1. Seems like a lot of people have these. I always thought they were some kind of mole. I noticed that I have one on my eyelid. I have had it for years. Not sure if you can just get one and it be the same thing or not. What is the difference between this and keratosis pilaris?

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