Fox-Fordyce Disease Research Articles

Adverse Events of Light-Assisted Hair Removal: An Updated Review.

With light-assisted hair removal becoming widely used, reports of adverse effects are increasing. To review all the reported optical incidents and cutaneous complications of laser or intense pulse light-assisted hair removal. A PubMed database systematic search was performed to identify studies reporting such adverse events before July 2022 using the Mesh terms "adverse effects" AND "hair removal" AND ("laser" OR "intense pulse light"). Altogether, 358 references were identified. After excluding duplicates, unrelated articles, guidelines, and conference abstracts, then adding references from studies bibliography, 104 publications were included. Ocular incidents consisted of anterior uveitis, iritis and iris atrophy, pupillary distortion, posterior synechiae, anterior chamber pigment, and cataracts in the anterior subcapsular region. Cutaneous complications consisted of pain, burns, folliculitis, leukotrichia, paradoxical hypertrichosis, pigmentary changes, changes in nevi, pili bigemini, herpes infection, hyperhidrosis, bromhidrosis, Fox-Fordyce disease, and frostbite from the cooling system. They were mostly correlated to skin type and body area as well as to light device and set parameters. Intense pulse light devices were found to be less painful than alexandrite laser, yet more painful than diode laser; Nd:YAG laser had the highest pain score. Optical incidents can be systematically avoided. Cutaneous complications are usually related to professional errors and patient characteristics. Better knowledge of laser physics and adequate training of laser operators are key recommendations to avoid undesirable side effects. Safety recommendations help prevent most of the reported complications.

Refractory pruritic Fox-Fordyce disease successfully treated with botulinum toxin type A

Refractory pruritic Fox-Fordyce disease successfully treated with botulinum toxin type A

Treatment of pruritus with botulinum toxin in a pediatric patient with Fox-Fordyce disease.

Fox-Fordyce disease is a chronic pruritic disorder of apocrine sweat glands that is often associated with significantly decreased quality of life. With no definitive cure, affected patients are often treated with topical corticosteroids as first-line therapy, but evidence for treatment of refractory cases is limited. We present an adolescent with Fox-Fordyce disease successfully treated for symptomatic relief with botulinum toxin type A injections. While previously reported in an adult patient, we detail the efficacy of this therapy in a pediatric patient.

Pathophysiology, clinical findings, and management of Fox-Fordyce disease: A systematic review.

Fox-Fordyce (FFD), also known as apocrine military, is an uncommon chronic inflammation of the apocrine sweat glands. It is characterized by pruritic, papular eruptions in apocrine-gland-bearing regions. FFD was described a century ago, but the exact pathogenesis of the disease and the management are not well understood. This paper provides a wide understanding of the pathophysiology, clinical findings, and management of Fox-Fordyce disease. Its aim is to help the physician to diagnose and manage this entity accordingly. A research was done using PubMed database on 12 April 12, 2020, and in order to retrieve all case reports, case series, cohort studies, randomized, and nonrandomized clinical trials were included describing FFD among patients. A total of 43 articles and 68 patients were included in the study. The majority of patients were young females. The disease was bilateral in 90%, affected the axillae and to a lesser extent the pubic and the periareolar areas and rarely the thoracic area, the abdominal area, and the face. FFD followed a relapsing and remitting course, and an evident improvement in disease course was noted after menopause. The typical FFD patient is a post-pubertal female and pre-menopause, presenting with pruritic papules in apocrine-gland-bearing regions. FFD can be sporadic or occurs in family, and it can be asymptomatic in 1/(3-4) of patients and can be triggered by laser hair removal and hormonal changes. Further randomized clinical trials assessing different treatment of FFD are now warranted.

Axillary Fox-Fordyce Disease Induced By Laser Hair Removal

Fox-Fordyce disease (FFD) is an uncommon chronic inflammatory skin disease of the apocrine sweat glands that could be considered as a rare adverse event of laser hair removal. It is postulated that laser therapy could induce damage to the follicular infundibulum, resulting in epidermal detachment and altered keratinocytes maturation which led to keratin plugging. Here, we present a case of a post-pubertal woman who developed axillary itchy lesions with clinical and histological features compatible with FFD, after a series of axillary laser hair removal treatments.

Fox-Fordyce disease on the peristernal region: a rare and atypical case

Syringomas are benign tumors of cutaneous appendages of eccrine or apocrine origin affecting approximately 1% of the population. They mainly occur in women and they commonly manifest as soft skin-colored or slightly yellowish papules on the lower eyelid and the upper part of the cheeks. More rarely, syringomas can even occur on the neck, the armpits, the breasts, the lower portion of the abdomen, the thighs and the groin. Clinically, they can be distinguished from xanthelasmas, warts or cancers because they are monomorphic and have a regular distribution. In doubtful cases, the diagnosis is confirmed by biopsy. Syringomas can be easily detected on histological examination due to the presence of comma-shaped sweat ducts in the dermis. Even though syringomas are benign tumors, their appearance can be embarrassing to the patients. Therapeutic options, mainly supported by small case series and case reports, include surgical excision, electrodessication, curettage, chemical exfoliation, cryosurgery and laser treatment. However, as these tumors lie deep in the dermis, all treatments are associated with a substantial risk of recurrence and can cause scars and skin pigment changes. We here report the case of a 40-year old woman with no previous history, presenting with skin-colored periorbital papules whose histological examination showed syringomas.

Fox-Fordyce disease: report of two cases with perifollicular xanthomatosis on histological image

Fox-Fordyce disease is a relatively infrequent pathology of the apocrine glands that affects almost exclusively young women. The disease is characterized by the presence of pruritic follicular papules mainly in the armpits that respond poorly to treatment and severely affect the patient’s quality of life. We report two cases with clinical diagnosis and histopathological confirmation, presenting perifollicular xanthomatosis on histological examination, recently described as a distinctive, consistent, and specific feature of this disease.

Can Fractionated Microneedle Radiofrequency be an Effective Procedure for Treatment of Fox–Fordyce Disease? A Medical Hypothesis

Can Fractionated Microneedle Radiofrequency be an Effective Procedure for Treatment of Fox–Fordyce Disease? A Medical Hypothesis

Stripping off apocrine sweat glands for the treatment of a case of Fox-Fordyce disease

Stripping off apocrine sweat glands for the treatment of a case of Fox-Fordyce disease

Professional interest in dermatopathology of Stanisław Ostrowski - the only one State Polish President among physicians.

President of prewar Lvov and Polish Republic on Exile, associate professor Stanisław Ostrowski was a dermatologist with a keen interest in dermatopathology. This study was based on original resources, which - mainly reports of his own authorship - were focused on dermatopathology. Stanisław Ostrowski provided excellent description of naevus epitheliomatosus sebaceus Wolters-Friboes both in Polish and German to be cited after decades in renowned handbooks of dermatopahtology published by Springer Verlag. His scientific output also includes meticulous presentation of Fox-Fordyce disease (apocrine miliaria) as well as gold-induced skin changes to Polish readership. Thus, this study documents dermatopahtological achievements of Stanisław Ostrowski - the unifying statesman of society of Lvov and Polish emigration in London.

Fox-Fordyce Disease: An under-diagnosed adverse event of laser hair removal?

Fox-Fordyce Disease (FFD) is a rare chronic inflammatory skin disease of the apocrine glands, mainly affecting post-pubertal women. It involves apocrine gland-bearing areas including the axilla, areola, anogenital area and umbilicus. FFD induced by laser hair removal is a newly reported entity of unknown pathogenesis. To the best of our knowledge, there are only four reported cases in the literature describing a total of four patients. We are reporting the first case series of laser-induced FFD with a histopathological and clinical evaluation of the reported cases. A review of the available literature to date about laser-induced FFD was performed. Clinical and histopathological features were reviewed. In our case series, the clinical and histological appearance of FFD following laser hair removal is similar to that of classic FFD. Exacerbating factors were present in two patients, and were similar to that of classic FFD. The main histopathological features included dilatation of the follicular infundibulum, follicular hyperkeratosis, dyskeratosis in the follicular infundibulum, periductal lymphohistiocytic infiltrate and perifollicular fibrosis. Two of the four reported cases as well as one of our patients had no perifollicular xanthomatous inflammation, a hallmark feature of classic FFD. Mast cells were absent in all reported cases, as well as in our patients. We believe that laser-induced FFD is under-diagnosed as a newly reported adverse event of laser hair removal. It is clinically and histopathologically similar to classic FFD.

Case report: A novel modality using microwave technology for the treatment of Fox-Fordyce disease

Case report: A novel modality using microwave technology for the treatment of Fox-Fordyce disease

Inflammatory and glandular skin disease in pregnancy

A switch from cell-mediated to humoral immunity (helper T 1 [Th1] to helper T 2 [Th2] shift) during gestation plays a key role in placental immune tolerance. As a result, skin diseases that are Th2 mediated often worsen, whereas skin diseases that are Th1 mediated often improve during gestation. Also, due to fluctuations in glandular activity, skin diseases involving sebaceous and eccrine glands may flare, whereas those involving apocrine glands may improve during pregnancy. Despite these trends, inflammatory and glandular skin diseases do not always follow the predicted pattern, and courses are often diverse. We review the gestational course of inflammatory skin diseases, such as atopic dermatitis (atopic eruption of pregnancy), psoriasis, impetigo herpetiformis, urticaria, erythema annulare centrifugum, pityriasis rosea, sarcoidosis, Sweet syndrome, and erythema nodosum, as well as glandular skin diseases, including acne vulgaris, acne rosacea, perioral dermatitis, hidradenitis suppurativa, Fox-Fordyce disease, hyperhidrosis, and miliaria. For each of these diseases, we discuss the pathogenesis, clinical presentation, and management with special consideration for maternal and fetal safety.

Fox-Fordyce Disease.

A 42-year-old woman presented to the Department of Dermatology & Venereology, Virgen de las Nieves Hospital, Granada, Spain, in May 2015 with a severe pruritic rash and hair loss in both axillary regions. Physical examination showed skin coloured papules and alopecia [Figure 1A], which showed no fluorescence under a Wood’s lamp. Dermoscopy revealed hair follicle-centred papules, traumatised terminal hairs and blackheads [Figure 1B]. The histology of the skin biopsy indicated an inflammatory infiltrate of lymphocytes affecting the follicle [Figure 1C] and the obstruction of the eccrine and apocrine sweat glands [Figure 1D]. The patient was diagnosed with Fox-Fordyce (FF) disease. Following treatment with tretinoin (0.05%), she demonstrated moderate symptomatic improvement. Figure 1A–D: A 42-year-old woman with Fox-Fordyce disease with (A) skin coloured papules of 1–2 mm and moderate alopecia in the right axilla and (B) folliculocentric papules with a few traumatised terminal hairs and blackheads. Haematoxylin and eosin stains ...

Clinical Effects of Topical Tacrolimus on Fox-Fordyce Disease.

Fox-Fordyce Disease (FFD) is a rare, chronic, pruritic, inflammatory disorder of apocrine glands. It is characterized by dome-shaped, firm, discrete, skin-colored, and monomorphic perifollicular papules. The most common sites of involvement are axillae and anogenital and periareolar regions which are rich in apocrine sweat glands. Treatment is difficult. Topical, intralesional steroids, topical tretinoin, adapalene, clindamycin, benzoyl peroxide, oral contraceptives, isotretinoin, phototherapy, electrocauterisation, excision-liposuction and curettage, and fractional carbon dioxide laser are among the treatment options. In the literature, there are articles reporting beneficial effects of pimecrolimus in FFD. Nevertheless, there have not been any reports about the use of tacrolimus in FFD. We report two patients diagnosed with FFD by clinical and histopathologic examination and discussed therapeutic effects of topical tacrolimus on FFD in the light of literature.

Axillary syringomas mimicking Fox-Fordyce disease.

Axillary syringomas mimicking Fox-Fordyce disease.

Deciphering the functions of the hair follicle infundibulum in skin physiology and disease.

The infundibulum is the funnel-shaped, uppermost epithelial segment of the hair follicle. Thus, as the infundibulum represents a major interface zone of mammalian skin epithelium with the environment and harbors a rich residential microflora, it is not surprising that this area is endowed with a specialized immune system and innate immune defenses. Clinically, the infundibulum is quite important, as it becomes prominently involved in many skin diseases such as acne, infundibular folliculitis and cysts, hidradenitis suppurativa, keratosis pilaris, Fox-Fordyce disease, and a subtype of basal cell carcinoma. Nevertheless, the biology of the infundibulum is only poorly understood, and it remains largely unknown how exactly the infundibulum contributes to skin disease, and how it might be targeted effectively for treating important skin diseases. Several recent studies in mouse models have identified new potential infundibular markers, shed light upon infundibular development and homeostasis, identified infundibular epithelial stem cells, and have implicated the infundibulum in the pathogenesis of additional skin disorders. These recent insights encourage one to systematically re-visit the biology and pathology of the infundibulum, one of the most important, yet least-studied frontiers in mammalian epithelial physiology.

Fox–Fordyce disease treatment with fractional CO2 laser

Fox–Fordyce disease treatment with fractional CO₂ laser

Fox–Fordyce-like disease following laser hair removal appearing on all treated areas

Fox-Fordyce disease is an uncommon inflammatory disease of the apocrine sweat glands. Two recent reports indicated laser hair removal as a novel cause of axillary Fox-Fordyce disease. We report the first case of Fox-Fordyce disease developing in women after completing treatment with a depilatory hair laser appearing in the axillae, umbilicus, and pubis. We describe a case of Fox-Fordyce disease that developed in a 27-year-old woman 3months after she had completed two LightSheer Diode laser treatments of her axilla, periumbilical region, and bikini area. Clinical and histopathological changes are as well detailed. Laser therapy induces damage to follicular infundibulum, resulting in altered maturation of keratinocytes which led to keratin plugging causing the common pathologic features in Fox-Fordyce disease. Differences in the physiologic features of the anatomic sites, in the susceptibility to laser-induced injury among these areas, or additional factors may contribute to Fox-Fordyce disease.

Diseases associated with hidranitis suppurativa: part 2 of a series on hidradenitis

Hidradenitis suppurativa (HS), a pathologic follicular disease, impacts patients' lives profoundly and usually occurs in isolation. The diseases with the strongest association are obesity, depression, and pain. HS is associated with many diseases including acne conglobata (AC), dissecting cellulitis, pilonidal cysts, and obesity. Pyoderma fistulans sinifica (fox den disease) appears to be the same entity as Hurley Stage 2 of 3 HS. The rate of acne vulgaris in HS patients mirrors unaffected controls. The most common, albeit still uncommon, association is with seronegative, haplotype unlinked arthritis (most importantly B27), in particular spondolyarthritis. Crohn disease and HS occur together at a rate that varies from 0.6% to 38% in retrospective cases series. Ulcerative colitis occurred with HS in 14% of patients in one series. The next most common association is with pyoderma gangrenosum, but this association is likely under-reported. Synovitis-Acne-Pustulosis Hyperostosis-Osteitis (SAPHO) syndrome, which is rare, has more than 10 reports linking it to HS. Nine case reports have linked Dowling-Degos disease (DDD) to HS and two reports related HS to Fox-Fordyce disease (FF), but because both occur in the axilla this might be a mere coincidence. HS is rarely associated with ophthalmic pathology. Specifically, more than 5 reports link it to Keratitis-Ichthyosis-Deafness syndrome (KID); greater than10 cases link it to interstitial keratitis and 2 cases are linked to Behçet's disease. The presence of proteinuria and acute nephritis link HS to the kidney, especially since and reports have documented resolution of HS after renal transplant. Florid steatocystoma multiplex, Sjogren Syndrome, and HS have been linked and their reports likely underestimate their coincidence because all these entities involve occlusion (albeit by different mechanisms). Three reports link HS and amyloid, but both share some common genetic underpinnings and thus the coincidence of these diseases is likely underreported. Pyoderma vegetans has been noted in 2 cases of HS and 4 cases of Inflammatory Bowel Disease (IBD) and is likely a clue to the linkage of the pathology of IBD and HS. Pityriasis rubra pilaris, in particular Type VI related to HIV, has a relationship more commonly with acne conglobata, but with HS also. Single case reports of diseases associated with HS include systemic lupus erythematosus, acromegaly, Down syndrome, Bazex-Dupre´-Christol, and prurtis ani, but these might be coincidences. Pyogenic Arthritis, Pyoderma gangrenosum, and Acne (PAPA Syndrome) and Pyoderma gangrenosum, Acne, and Suppurative Hidradenitis (PASH Syndrome) are pyodermic-arthritic syndromes that are associated with HS. Erythema nodosum and granulomatous lobular mastitis have been reported with HS but the significance of these reports is uncertain. Because of scarring, HS can result in lymphedema including scrotal elephantiasis and verrucous lymphedema. HS is sometimes accompanied by obesity, hypertension, and anemia and can be considered a disease in the spectrum of metabolic syndrome, a skin disease with systemic consequences. HS, like other types of chronic inflammation when long standing in the perianal and perineal areas, can result in squamous cell cancer. A variety of drugs can induce HS. These include lithium, sirolimus, cyclosporine, vemurafenib, and oral contraceptives. Inverse psoriasis or psoriasis vulgaris as a side effect of infliximab therapy may be associated with HS. These associations aside, most cases of HS occur in isolation without coincident morbidity.