An otherwise healthy 35-year-old man was referred to the dentistry and oral surgery department with asymptomatic granules on the buccal mucosa. Intraoral examination showed multiple small, white to yellow papules on both sides of the buccal mucosa (Figure 1). Extraoral examination showed no significant abnormalities. A clinical diagnosis of Fordyce spots was made.
The patient presented with multiple, small, white to yellow papules on the buccal mucosa (left buccal mucosa shown here).
FORDYCE SPOTS: PREVALENCE AND KEY FEATURES
Fordyce spots are ectopic sebaceous glands on the oral and genital mucosa and are considered a normal variant.1,2 In the oral cavity, the spots often present on the buccal mucosa, the vermillion border of the upper lip, and the retromolar region. The estimated prevalence of Fordyce spots is 0.5% to 6.6%.3 No genetic and geographic differences have been reported. They are mostly found in male adults or people with oily skin types, and the incidence increases with age, predominantly in the elderly.1,4
Fordyce spots appear as multiple, small, slightly elevated, whitish to yellowish papules measuring 0.2 mm to 2 mm in diameter,1,4 and they cannot be removed by scraping. In most patients, Fordyce spots are asymptomatic, but some patients feel a rough mucosal sensation.2
The pathogenesis of Fordyce granules remains poorly understood,4 and no association between Fordyce spots and specific drugs has been reported. According to a cross-sectional prospective study, hyperlipidemia has been associated with a high density of granules,5 and a case series showed the presence of Fordyce spots in patients with hereditary nonpolyposis colorectal syndrome.6
The lesions are often misdiagnosed as a fungal infection or oral lichen planus.2 No treatment is required except for cosmetic reasons.1,4
DISCLOSURES
The authors report no relevant financial relationships which, in the context of their contributions, could be perceived as a potential conflict of interest.
- Copyright © 2022 The Cleveland Clinic Foundation. All Rights Reserved.
REFERENCES
- 1↵Pinna R, Cocco F, Campus G, et al. Genetic and developmental disorders of the oral mucosa: epidemiology; molecular mechanisms; diagnostic criteria; management. Periodontol 2000 2019; 80(1):12–27. doi:10.1111/prd.12261
- 2↵del la Vella F, Lauritano D, Lajolo C, et al. The pseudolesions of the oral mucosa: differential diagnosis and related systemic conditions. Applied Sciences 2019; 9(12):2412. doi:10.3390/app9122412
- 3↵Oivio UM, Pesonen P, Ylipalosaari M, Kullaa A, Salo T. Prevalence of oral mucosal normal variations and lesions in a middle-aged population: a Northern Finland birth cohort 1966 study. BMC Oral Health 2020; 20(1):357. doi:10.1186/s12903-020-01351-9
- 4↵Lee JH, Lee JH, Kwon NH, et al. Clinicopathologic manifestations of patients with Fordyce’s Spots. Ann Dermatol 2012; 24(1):103–106. doi:10.5021/ad.2012.24.1.103
- 5↵Gaballah KY, Rahimi I. Can presence of oral Fordyce’s granules serve as a marker for hyperlipidemia? Dent Res J (Isfahan) 2014; 11(5):553–558. pmid:25426145
- 6↵Almeida FT, Gomes RR, Leite AF, Sousa JB, Acevedo AC, Guerra EN. Oral manifestations of hereditary nonpolyposis colorectal cancer syndrome: a family case series. J Med Case Rep 2014; 8:249. doi:10.1186/1752-1947-8-249
