Clinicopathologic Manifestations of Patients with Fordyce's Spots

Abstract

Editor: In 1896, Fordyce1 described whitish spots on the vermilion border of the lips, oral mucosa and, rarely, genital mucosa. Fordyce's spots are ectopically located sebaceous glands1-4. To date, few reports have been published to describe the clinicopathologic study of Fordyce's spots in the Korean population. We herein review the clinicopathologic characteristics of Korean patients with Fordyce's spots. Data were collected retrospectively from the medical records of patients diagnosed with Fordyce's spots between January 2000 and December 2009 in the Department of Dermatology of 4 medical centers in Korea. We reviewed biopsy slides, treatment regimens, and other relevant information. Sixteen patients were finally enrolled in this study. All patients were confirmed with Fordyce's spots following biopsy. This study was approved by the Institutional Review Board of the Catholic University of Korea. Distribution of the patients' age, sex, incubation period, symptoms, signs, anatomical locations, and treatment were evaluated. Histopathologically, the morphology of Fordyce's spots, distribution, and existence of sebaceous ducts-whether they opened onto the skin surface or not-were investigated. The male to female ratio was 11 : 5. The average patient age was 34.3 years and ranged from 17~67 years (mean±S.D., 34.3±15.0 years). The average age was 41.1 years old in men and 19.4 years old in women. Duration of illness prior to diagnosis ranged from several days to five years, and the mean incubation period was 1.9 years. Most patients were asymptomatic. However, one patient with concurrent contact dermatitis complained of pruritus. The observed lesions were multi-centric and whitish to yellowish in color. Slightly elevated papules and plaques with sizes ranging from 1 to 3 mm were seen. In 8 patients, the lesions were found on the upper lip (50%), on both lips in 4 (25%), and on the lower lip in two (12.5%) (Fig. 1A, B). The spots mostly presented on the vermilion portion of the lips. The lesions in one patient presented on the buccal mucosa (Fig. 1C) and glans penis, respectively. The family history of the patient was unknown. Two patients were treated with a carbon dioxide (CO2) laser, 1 with electrodessication (E/D), 5 with excision of the lesions, and 7 were put on observation. Among those treated, no recurrence was reported (Table 1). Fig. 1 Multiple, pin-head-sized, whitish to yellowish papules on the vermilion border of both lips in case 9 (A), upper lip in case 11 (B), and buccal mucosa in case 8 (C). Table 1 Epidemiologic and clinical characteristics of 16 study patients with Fordyce's spots Histologically, the size of sebaceous glands ranged from 1.62±0.55 mm. The glands were located in both the upper dermis (81.3%) and lower dermis (18.7%). The sebaceous glands of Fordyce's spots mostly do not associate with hair follicles. Sebaceous ducts of Fordyce's spots have been observed to open directly onto the surface of the skin (81.3%, Fig. 2). Fig. 2 Sebaceous glands in the dermis on the lip in case 11 (A) and in case 13 (B). Fordyce's spots open directly onto the surface and do not associate with hair follicles (H&E, ×100).