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What are Fordyce granules?
Last reviewed: 15.04.2022
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Visible sebaceous glands of the skin - in the form of small nodules (papules) of various localization - were first described in 1861 by the Swiss anatomist Albert Kölliker, but they received the name Fordyce granules by the name of another doctor, the American dermatologist John Fordyce, who reported them 45 years later … [1]
Epidemiology
According to some estimates, Fordyce's granules or glands, as a variant of the anatomy, occur in 70-80% of adults and are twice as common in men.
Their most common localization (more than 80% of cases) is the red border of the upper or lower lip; then - the retromolar region, that is, the Fordyce granules on the gums behind the last molars. A significant number of cases also occur in Fordyce granules on the cheeks (on their mucous membrane in the oral cavity).
Causes of the fordyce granules
But even today, the key reasons for the appearance of Fordyce granules are unknown, while there are several assumptions about their relative origin.
Some researchers believe that the increase in sebaceous glands not associated with hair follicles occurs with hormonal changes - especially during puberty. According to the second point of view, these fatty nodules begin to form during fetal development, and in children before puberty they are simply not visible.
However, most dermatologists consider accumulations of sebaceous glands shifted closer to the surface of the skin (ectopic or heterotopic), covered with intact epithelium or mucous membrane, an anatomical variant. That is, in fact, these granules are formed due to the peculiarities of the development of the sebaceous glands - their number and depth in the skin - in the embryonic period.
When asked whether Fordyce granules are contagious, experts give an unambiguously negative answer, although these papules, which are completely harmless to physical health (and not associated with any infection), can cause anxiety in people. [2]
Risk factors
With a rather uncertain etiology, it is difficult for specialists to establish unconditional risk factors for the appearance of Fordyce's glands.
Most often, as the conclusions of clinical observations or assumptions, an oily skin type with severe seborrhea, male sex (cells of the sebaceous glands are stimulated by testosterone and dihydrotestosterone), elevated blood lipid levels (hyperlipidemia) and age up to 30-35 years, when these glands become noticeable.
Pathogenesis
The sebaceous glands (glandulae sebacea) are located in close proximity to the hair follicles (folliculus pili); they produce sebum, which enters the surface of the skin through the follicular duct - to protect the epidermis.
Both the size of these glands and the activity of sebum secretion are controlled by male steroid hormones - androgens. The sebaceous glands enlarge during preadolescence due to androgen stimulation of the adrenal glands and reach their full size during puberty, when androgens also begin to be produced by the gonads (sex glands).
And the pathogenesis of Fordyce granules on various parts of the body is associated with displacement and enlargement of the sebaceous glands, not associated with hair follicles; at the same time, their ducts go into the surface layers of the dermis and mucous membranes, where limited accumulations of sebum are formed (the composition of the granules and sebaceous glands is identical).
It should be borne 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 Fordyce granules under the eyes, and the presence of modified sebaceous glands (called Montgomery's glands) on the areola of the nipples may explain 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. And in women, Fordyce granules on the labia (labia majora and labia minora), as well as Fordyce granules on the clitoris, are an anatomical feature of the smallest sebaceous glands located in the mucosa of the so-called clitoral hood - the inner leaf of its foreskin. [3]
Symptoms of the fordyce granules
Symptoms of Fordyce granules are limited by the presence under the epithelium of small (1-3 mm in size) isolated papules (tubercles or pimples) of cream or yellowish-white color - on the lips or mucous membrane in the mouth, on the penis, scrotum and labia; often 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 shaft of the penis and scrotum, the papules become more pronounced when the skin is stretched.
Fordyce granules in the mouth - on the buccal mucosa - can be on both sides, single or multiple, but the mucosa surrounding them remains unchanged. In the ICD-10, Fordyce's ectopic sebaceous glands in the mouth are classified as congenital anomalies of the oral cavity with the code Q38.6.
By the way, in domestic dermatology, glands or Fordyce granules on the male genitalia can be considered sebaceous gland cysts or atheroma of the scrotum, testicles and penis , although cystic formation occurs in the sebaceous glands associated with hair follicles. [4]
Usually, Fordyce granules in the armpits, in the groin, in the pubic area, where sweat apocrine and sebaceous glands associated with hair follicles (having excretory ducts) predominate, are formed as the primary element of a rash in Fox-Fordyce disease in women - apocrine miliaria (code L75.2 according to ICD-10), which manifests itself as a perifollicular nodular rash with severe itching and the formation of keratin plugs.
Complications and consequences
Physical consequences in the presence of Fordyce granules are not observed, but there is often anxiety and depression - due to a cosmetic defect. True, when they appear on the penis, discomfort during intercourse is possible.
A complication can be inflammation of the Fordyce granules if the skin at their location is damaged. For example, when there are Fordyce granules on the lips, and permanent lip makeup touches them.
Diagnostics of the fordyce granules
Diagnosis of Fordyce granules includes visual inspection and skin examination . [5]
Instrumental diagnosis is usually carried out using dermatoscopy, ultrasound of the skin and subcutaneous fat can also be used .
Differential diagnosis
Differential diagnosis is carried out with steatocystomas (congenital sebaceous cysts), epidermoid or dermoid cyst, sebaceous gland hyperplasia, atheroma, xanthomas, whiteheads (milia), syringomas, perioral dermatitis, vegetarian pyostomatitis, leukoplakia. Molluscum contagiosum. [6]
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Treatment of the fordyce granules
Most dermatologists do not consider it necessary to treat ectopic sebaceous glands. But to eliminate a cosmetic defect, it is possible to use some medications containing retinol (vitamin A).
So, local remedies with retinoids - the active form of vitamin A (isotretinoin) - can be used in the form of an ointment (cream or gel), that is, retinoic ointment from Fordyce granules; Tretinoin, Atrederm solution or Retin A cream; gel or cream Adapalen (Adaklin, Differin) - with an analogue of retinoic acid. These funds are applied to the skin once a day. However, one should keep in mind their possible side effects, which are manifested by swelling, redness, peeling and itching of the skin. [7]
Locally applied salicylic and bichloroacetic acid, calcipotriol betamethasone [8]
A possible physiotherapeutic treatment is sessions of photodynamic therapy with 5-aminolevulinic acid. [9]
Herbal treatment is limited to lotions with tincture of Canadian sanguinaria root (Sanguinaria canadensis), 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 moisten them with natural apple cider vinegar diluted with water (1: 1).
How to remove Fordyce granules? Fordyce granules are removed with a laser (ablative carbon dioxide or pulsed), as well as by electrocoagulation or cryotherapy. And with large sizes of sebaceous papules, surgical treatment is possible - their removal with the help of micropunctures. [10]
Prevention
So far, there are no methods for preventing the appearance of ectopic sebaceous glands.