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What are Fordyce granules?
Last reviewed: 07.06.2024
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Conspicuous sebaceous glands of the skin - in the form of small nodules (papules) of various localizations - were first described in 1861 by Swiss anatomist Albert Kelliker, but they received the name Fordyce granules after another physician, American dermatologist John Fordyce, who reported them 45 years later.... [1]
Epidemiology
By some estimates, granulomas or Fordyce's glands, as a variant anatomy, occur in 70-80% of adults and are twice as common in males.
Their most frequent localization (more than 80% of cases) is the red border of the upper or lower lip, followed by the retromolar region, i.e. Fordyce granules on the gums behind the last molars. Fordyce granules on the cheeks (on their mucous membrane in the oral cavity) also account for a significant number of cases.
Causes of the fordyce granules
But even to date, the key causes of Fordyce's granules are unknown, with several speculations as to their relative origins.
Some researchers believe that an increase in sebaceous glands not associated with hair follicles occurs with hormonal changes - especially during puberty. The second view is that these fatty nodules begin to form during intrauterine development and are simply not visible in children until puberty.
However, most dermatologists consider clusters of sebaceous glands displaced closer to the skin surface (ectopic or heterotopic), covered by intact epithelium or mucous membrane, to be an anatomical variant. That is, in fact, these granules are formed due to the peculiarities of sebaceous gland development - their number and depth in the skin - during the embryonic period.
To the question of whether Fordyce granules are contagious, experts give an unequivocal negative answer, although these papules, which are not dangerous to physical health (and are not associated with any infection), can cause people concern. [2]
Risk factors
With a rather uncertain etiology, it is difficult for specialists to establish unconditional risk factors for Fordyce's glands.
The most commonly cited findings from clinical observations or assumptions are an oily skin type with severe seborrhea, male gender (sebaceous gland cells are stimulated by testosterone and dihydrotestosterone), elevated blood lipid levels (hyperlipidemia), and age before 30-35 when these glands become prominent.
Pathogenesis
Sebaceous glands (glandulae sebacea) are located in close proximity to hair follicles (folliculus pili); they produce sebum, which reaches the skin surface through the follicular duct - to protect the epidermis.
Both the size of these glands and the activity of sebum secretion are controlled by the male steroid hormones androgens. The sebaceous glands enlarge during pre-adolescence due to androgen stimulation of the adrenal glands and reach their full size during puberty, when androgens are also produced by the gonads (sex glands).
And the pathogenesis of Fordyce granules on different parts of the body is associated with the displacement and enlargement of sebaceous glands, not associated with hair follicles; in this case, their ducts exit into the superficial layers of the dermis and mucous membranes, where limited accumulations of sebum are formed (the composition of granules and sebaceous glands is identical).
Keep in mind that most adults have very small sebaceous glands on the red border of the lips, so Fordyce granules on the lips may appear.
In addition, tiny sebaceous glands are present on the eyelids, which may explain the Fordyce granules under the eyes, and the presence of modified sebaceous glands (called Montgomery's glands) on the areolae of the nipples may explain the Fordyce granules on the breasts and nipples.
In men, Fordyce granules on the penis may be associated with ectopia and enlargement of the preputial sebaceous glands - under the foreskin (preputium) of the penis. In women, Fordyce granules on the labia majora and labia minora, as well as Fordyce granules on the clitoris, are anatomical features of the smallest sebaceous glands located in the mucosa of the so-called hood of the clitoris - the inner leaf of the foreskin. [3]
Symptoms of the fordyce granules
The symptoms of Fordyce granuloma are limited to the presence of small (1-3 mm in size) isolated papules (tubercles or pimples) of cream or yellowish-white color under the epithelium on the lips or mucous membrane in the mouth, penis, scrotum, and labia; often the papules cause local elevation of the epithelium covering them.
Nodules located next to each other can sometimes merge, but remain asymptomatic: they do not cause pain, itching, etc. On the penile shaft and scrotum, the papules become more pronounced when the skin is stretched.
Fordyce granules in the mouth - on the cheek mucosa - may be on both sides, single or multiple, but the surrounding mucosa remains unchanged. In ICD-10, ectopic sebaceous glands of Fordyce's mouth are categorized as congenital anomalies of the oral cavity with code Q38.6.
Incidentally, in domestic dermatology, Fordyce's glands or granules on the male genitalia may be considered sebaceous gland cysts or atheroma of the scrotum, testicles, and penis, although the cystic formation occurs in the sebaceous glands associated with hair follicles. [4]
Usually Fordyce granules in the armpits, groin, pubic area, where apocrine sweat glands and sebaceous glands associated with hair follicles (which have ducts) predominate, are formed as the primary rash element in Fox-Fordyce disease in women - apocrine sweating (ICD-10 code L75.2), which is manifested by perifollicular nodular rash with severe itching and formation of keratinous plugs.
Complications and consequences
There are no physical consequences with the presence of Fordyce granules, but there is often anxiety and depression - because of the cosmetic defect. However, if they appear on the penis, discomfort during sexual intercourse is possible.
A complication can be inflammation of the Fordyce granules if the skin where they are located is damaged. For example, when there are Fordyce granules on the lips and the permanent lip makeup touches them.
Diagnostics of the fordyce granules
Diagnosis of Fordyce granulomas includes visual inspection and skin examination. [5]
Instrumental diagnosis is usually performed using dermatoscopy, ultrasound of the skin and subcutaneous fat can also be used.
Differential diagnosis
Differential diagnosis is made with steatocystomas (congenital sebaceous cysts), epidermoid or dermoid cysts, sebaceous gland hyperplasia, atheroma, xanthomas, white eels (milia), syringomas, perioral dermatitis, vegetative pyostomatitis, leukoplakia. Contagious molluscum. [6]
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Treatment of the fordyce granules
Most dermatologists do not consider it necessary to treat ectopic sebaceous glands. But it is possible to use some medications containing retinol (vitamin A) to eliminate the cosmetic defect.
So, topical agents with retinoids - the active form of vitamin A (isotretinoin) - in the form of ointment (cream or gel) can be used, that is retinoic ointment from Fordyce granules; Tretinoin, Atrederm solution or Retin A cream; Adapalene gel or cream (Adaklin, Differin) - with an analog of retinoic acid. These products are applied to the skin once a day. However, you should be aware of their possible side effects, which are manifested by swelling, redness, peeling and itching of the skin. [7]
Salicylic and bichloroacetic acid, calcipotriol betamethasone are applied topically [8]
Possible physiotherapeutic treatment - sessions of photodynamic therapy with 5-aminolevulinic acid. [9]
Treatment with herbs is limited to lotions of tincture of Sanguinaria canadensis root, calendula and celandine. It is advised to lubricate the granules with a mixture of aloe juice and turmeric (Curcuma longa rhizome powder), as well as wetting them with natural apple cider vinegar diluted with water (1:1).
How to remove Fordyce granules? It is practiced to remove Fordyce granules by laser (ablative carbon dioxide or pulsed), as well as by electrocoagulation or cryotherapy. And if the sebaceous papules are large, surgical treatment is possible - removing them with micropunctures. [10]
Prevention
So far, there are no methods to prevent the appearance of ectopic sebaceous glands.