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A 42-year-old woman presents for evaluation of a lip condition that she finds both cosmetically bothersome and of medical concern. The patient is uncertain as to the onset of the spots and denies any symptoms including pain. She has a history of genital herpes infection and is convinced that the lip lesions are herpes as well. She demands both a culture and biopsy of the lesion to establish a diagnosis “as this is ruining my life.” Physical examination reveals multiple minuscule whitish-yellow papules of the vermillion border. No similar lesions are noted on her tongue or buccal mucosa. To reassure the patient, a shave biopsy is performed.
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Fordyce spots, also known as Fordyce granules, are ectopic sebaceous glands devoid of hair follicles that are found within the oral and/or genital mucosa. They were named after the physician, J.A. Fordyce, who first described these lesions in 1896.1 Dr Fordyce considered the condition a sign of disease although today clinicians consider them to be a normal variant of skin.2 Common areas of involvement are the outer lip, buccal mucosa, penis, and labia.
Fordyce spots classically present as 1 mm white to yellow papules that become accentuated when the skin is stretched. Dermoscopy (also termed mucosopy when performed on mucosa cells) reveals a vascular garland-like pattern in conjunction with yellowish bunch-like lobules.3 The opening of the sebaceous gland may present as a central opacity. Lesions are asymptomatic but may prove bothersome from a cosmetic standpoint. The incidence increases with age although sporadic case reports document occurrence in infants.4
Fordyce spots are benign and occur in a majority of adults. Biopsy is rarely indicated, although in this case, the patient would not accept simple reassurance. Various treatment modalities have proven successful including electrodesiccation, microneedling, and ablative laser.5-7
Stephen Schleicher, MD, is director of the DermDox Dermatology Centers, associate professor of medicine at Geisinger Commonwealth Medical College, and clinical instructor of dermatology at Arcadia University and Kings College.
References
1. Einstein S, Higgins J, Khaki IS. As Dr. Fordyce might say, a peculiar affection of the lips of a neonate. Pediatrics. 2020;146(1_MeetingAbstracts):464-465. doi:10.1542/peds.146.1MA5.464
2. Fordyce spots. American Osteopathic College of Dermatology (AOCD) website. Accessed April 4, 2023. https://www.aocd.org/page/FordyceSpots
3. Jakhar D, Kaur I. Mucoscopy of Fordyce’s spots on lips. Indian Dermatol Online J. 2019;10(4):498-499. doi:10.4103/idoj.IDOJ_185_18
4. Pijl EK, Engelberts AC. [An infant with yellow spots in the mouth]. Ned Tijdschr Geneeskd. 2014;158:A7557.
5. Chern PL, Arpey CJ. Fordyce spots of the lip responding to electrodesiccation and curettage. Dermatol Surg. 2008;34(7):960-962. doi:10.1111/j.1524-4725.2008.34187.x
6. Ahn GR, Park SJ, Lee CK, Kim BJ. A case of successful treatment of Fordyce spots with a single insulated microneedle radiofrequency device. Dermatol Ther. 2019;32(5):e13026. doi:10.1111/dth.13026
7. Ocampo-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. doi:10.1046/j.1524-4725.2003.29236.x
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