Symptoms
Fordyce’s glands are ectopic sebaceous glands located in atypical sites, on the lip or in the oral cavity, and may flow into each other. They are painless and asymptomatic, whitish-yellowish 1-3 mm spots (papules) that are colorfully demarcated from the red of the lip. They occur in up to 30-80% of the population and first appear during or after puberty, are absent in children, and are more common in old age. They may persist unchanged or disappear temporarily. They are reported to occur more frequently during the cold season. Fordyce’s glands do not cause health problems. However, they can be a psychosocial problem in some circumstances and can be considered cosmetically disturbing. Ectopic sebaceous glands also occur in numerous other locations, often on the shaft of the penis, for example. However, they are referred to as Fordyce’s glands in the strict sense only when they occur on the lip or in the oral cavity. John Addison Fordyce first described them in 1896 in the article “A peculiar affection of the mucous membrane of the lips and the oral cavity“. By extension, all ectopic sebaceous glands are also referred to as Fordyce’s glands.
Causes
It is a normal developmental variant and not a disease. Fordyce glands are present at birth but do not become prominent until during or after puberty or in later years due to hormonal changes.
Diagnosis
The diagnosis is made in medical treatment. Other skin diseases, such as warts, must be excluded. Fordyce’s glands can be confused with cold sores, but are easily distinguished from them because of the different signs.
Treatment
Treatment is not necessary from a medical point of view, since it is a benign and asymptomatic variant, but it can be justified aesthetically. Several methods have been described in the literature to reduce or remove the glands, including CO2 laser, electrodesiccation, curettage. Caustics such as dichloroacetic acid have also been used. Photodynamic therapy with 5-aminolevulinic acid seems unsuitable because it has too many side effects. Oral isotretinoin is mentioned in the literature as a drug option, but its use is not indicated in our view because of the numerous adverse effects in this indication, unless severe acne is treated at the same time. It has been observed that the glands disappear during acne treatment with isotretinoin, but reappear after the end of therapy. It may also be possible to treat the glands with topically applied retinoids such as isotretinoin or tretinoin. Scientifically, topical treatment has not been adequately studied, but it is conceivable that there are externally applied drugs that can cause the glands to disappear.
