The Clinical Picture

Asymptomatic granules on the buccal mucosa

Keiichi Ohta, DDS and Hitoshi Yoshimura, DDS, PhD
Cleveland Clinic Journal of Medicine December 2022, 89 (12) 676-677; DOI: https://doi.org/10.3949/ccjm.89a.22025

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.

Figure 1
Figure 1

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.

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