Fordyce spots are clusters of ectopic sebaceous glands that are not associated with a hair follicle that occur on mucosal surfaces and open directly onto the surface of the skin. They are a common, normal variant of skin usually seen on the outer border of the lip, inside lining of the cheeks, glans penis, and on the labia majora and minora. Fordyce spots are usually asymptomatic although they can be associated with itching. They affect both males and females of all ages although the incidence increases with age.
On physical examination, Fordyce spots appear as 1-3 mm, non-tender, pale, white, or yellow papules that are more visible with stretching of the skin. When there are many in number, they can appear as confluent patches on the skin.
Although these lesions are benign, they should be examined by a physician for an accurate diagnosis as the Fordyce spots can be confused with genital warts. Other differential diagnoses are milia, epidermoid cysts, and sebaceous hyperplasia. The cause is not clear, although some studies show an endocrine influence while others hypothesize that it is due to errors during embryogenesis.
Treatment consists of reassurance to the patient. Some patients may be uncomfortable with the appearance of Fordyce spots and may seek treatment for cosmetic purposes. Although cauterization and lasers such as the CO2 laser can be used with some success, the risk of scarring and further complications should always be considered.
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