Fordyce Spots

Benjamin Barankin, MD, FRCPC
Alexander K.C. Leung, MD, MBBS, FRCPC, FRCP
Volume 56 - Issue 4 - April 2016

AUTHORS:
Alexander K. C. Leung, MD
Clinical Professor of Pediatrics, University of Calgary, and Pediatric Consultant, Alberta Children’s Hospital, Calgary, Alberta, Canada
 

Benjamin Barankin, MD
Dermatologist, Medical Director, and Founder, Toronto Dermatology Centre, Toronto, Ontario, Canada

CITATION:
Leung AKC, Barankin B. Fordyce spots. Consultant. 2016;56(4):377-378.

 

An 18-year-old young man presented with multiple asymptomatic papules on his penis that had first been noted 5 years ago. The papules had increased slowly in size and number until a year ago, when they had stabilized. His medical history was otherwise unremarkable. In particular, there was no history of exposure to sexually transmitted infections or of penile discharge. He was not on any topical or oral medication. The lesions became more obvious during an erection. The patient was married and did not have problems with sexual intercourse.

Physical examination revealed numerous monomorphic, 1-mm, skin-colored papules on the penile shaft. A clinical diagnosis of Fordyce spots was made.

Discussion. In 1896, Fordyce1 described the occurrence of whitish spots on the oral mucosa and vermilion border of lips; the condition now bears his name. Subsequent to that, manifestations of these spots on other parts of the body have been described. Fordyce spots are enlarged, ectopic sebaceous glands that occur most commonly on the lips and buccal mucosa, and less commonly on the penis or labia.2 Although these glands are present at birth, they are not obvious until puberty when they enlarge in response to gonadal and adrenal androgenic hormones.3

Clinically, Fordyce spots on the penile shaft are characterized by minute whitish, yellowish, or skin-colored papules. Sometimes, a thick, chalky or cheesy material can be expressed by squeezing the lesion.4 These papules are more obvious when the foreskin is stretched or during penile erection.4 Fordyce spots usually are asymptomatic.2 Rarely, they may cause discomfort during sexual intercourse.5

The condition is benign. Treatment usually is not necessary, apart from reassurance.4 For patients who desire treatment, options include micropunch surgery, electrodesiccation and curettage, ablative laser therapy, topical tretinoin, and topical bichloracetic acid.2,5,6

Outcome of the case. The patient was reassured about the benign nature of the condition and that treatment was not necessary. At a 6-month follow-up visit, the lesions had remained stable.

References:

  1. Fordyce JA. A peculiar affection of the mucous membrane of the lips and oral cavity. J Cutan Genito-Urin Dis. 1896;14:413-419.
  2. Mutizwa MM, Berk DR. Dichotomous long-term response to isotretinoin in two patients with Fordyce spots. Pediatr Dermatol. 2014;31(1):73-75.
  3. Campo-Candiani J, Villarreal-Rodríguez A, Quiñones-Fernández AG, Herz-Ruelas ME, Ruíz-Esparza J. Treatment of Fordyce spots with CO2 laser. Dermatol Surg. 2003;29(8):869-871.
  4. Rane V, Read T. Penile appearance, lumps and bumps. Aust Fam Physician. 2013;42(5):270-274.
  5. Pallua N, Stromps JP. Micro-punch technique for treatment of Fordyce spots: a surgical approach for an unpleasant condition of the male genital. J Plast Reconstr Aesthet Surg. 2013;66(1):e8-e11.
  6. Plotner AN, Brodell RT. Treatment of Fordyce spots with bichloracetic acid. Dermatol Surg. 2008;34(3):397-399.