Sir,

Fordyce spots, also known as Fordyce granules or Fordyce glands,(1-8) are a type of skin condition characterized by enlarged ectopic sebaceous glands (i.e., oil glands). Fordyce spots are very common as they can occur in up to 70-80% of adults.

They are considered normal variants of the skin that are likely present at birth and may grow and become more visible after puberty and with increased age due to increased oil production in the skin and hormonal influences. Fordyce spots are often unnoticeable. However, they may appear to be more pronounced and visible during puberty; in those assigned male at birth; in individuals with certain conditions, such as colorectal cancer; or when the affected skin areas are stretched, such as during pregnancy [1,2].

Fordyce spots typically appear as one to three millimeter, whitish-yellow colored bumps that most commonly appear in areas of the skin where no hair follicles are present. Specifically, Fordyce spots most commonly appear symmetrically around the inside the lining of the cheeks as well as the vermilion border of the lips, which is the area where the lips and facial skin meet.

Less commonly, Fordyce spots may appear on the shaft of the penis, scrotum, labia majora, and/or labia minora and are typically purple or red in color in these locations. Fordyce spots can appear in isolation or scattered patterns, which may cluster in groups of 50-100 spots that appear as patches on the skin [3,4].

Fordyce spots are completely normal and benign variants of the skin. For some, they may be considered a cosmetic concern without any physical complications. In such cases, certain individuals may experience anxiety, depression, or emotional impacts due to the perceived unsightly appearance of Fordyce spots; those individuals may require reassurance and counseling. Additionally, if the Fordyce spots are present on genitalia, they may bleed during or after sexual intercourse.

The exact cause of Fordyce spots remains unknown and is likely due to a combination of biological and environmental factors. Fordyce spots are commonly caused by the overgrowth of ectopic sebaceous glands, which some studies have linked to hormonal changes and/or factors in embryo development [5].

Common risk factors that may be associated with the development of Fordyce spots include oily skin, post-pubertal age, male sex at birth, dyslipidemia, rheumatic disorders, and colorectal cancers.

Fordyce spots are commonly diagnosed by a healthcare professional upon visual inspection. Individuals who find their Fordyce spots bothersome; are experiencing any signs or symptoms related to them, such as bleeding, depression or anxiety; or are concerned about other diseases may seek diagnosis or treatment and medical advice from a healthcare professional.

It is important that Fordyce spots are accurately diagnosed as the differential diagnosis for Fordyce spots include other conditions, such as genital warts, epidermoid cysts, sebaceous hyperplasia, or milia. For example, sexually transmitted infections may initially resemble Fordyce spots on the genitals and may require treatment with medications [6].

Swabs of the affected skin areas may also be taken and tested for the presence of bacteria or viruses. If the swabs yield a negative result, a diagnosis of Fordyce spots may be likely. If systemic involvement is suspected, blood and urine samples may also be taken. A skin biopsy may be required in rare circumstances, where a sample of tissue is removed and examined under a microscope to rule out other conditions, like skin cancer.

Treatment of Fordyce spots may not be required as they are typically benign and harmless. However, certain individuals may opt for treatment due to cosmetic concerns.

Micro-punch surgery is a micro-punch technique in which a small pen-like device is used to punch the skin and remove unwanted tissue after application of a local anesthetic. This approach permits multiple Fordyce spots to be rapidly and effectively removed with minimal scarring.

Laser treatments, such as carbon dioxide (CO2) lasers (also known as electrodesiccation lasers), may also effectively remove Fordyce spots. However, this approach can cause scarring. Pulsed dye lasers may cause less scarring but are typically more expensive. Both laser treatments use concentrated beams of light to remove the spots at different wavelengths.

Other medical treatments such as topical tretinoin and/or oral isotretinoin may be used to shrink or remove Fordyce spots.

Any combination of micro-punch techniques, laser treatments, and topical/oral treatments may be prescribed by a healthcare professional. In situations where skin irritation occurs, mild topical steroids, such as hydrocortisone, may be prescribed for relief.

Fordyce spots may fade with time without any treatment. It is important to avoid picking or squeezing them, as these actions can lead to irritation and possible infection.

Fordyce spots are a typical variation of the skin characterized by enlarged oil glands. They usually become more visible when there is increased oil production in the skin, such as during puberty. Fordyce spots are typically a white to yellow color in nature, and commonly appear in areas of the skin where no hair follicles are present. The exact cause of Fordyce spots remains unknown and is likely due to a combination of biological and environmental factors, resulting in an overgrowth of sebaceous glands. The most common risk factors associated with the development of Fordyce spots include oily skin, post-pubertal age, male sex at birth, dyslipidemia, and colorectal cancers. Fordyce spots may be diagnosed by a healthcare professional upon visual inspection alone; however, in certain circumstances, swabs and/or biopsies of the skin may be taken to rule out other skin conditions with a similar presentation. Treatment of Fordyce spots may not be required; however, micro-punch surgery, laser treatments, and topical and/or oral medications may be used to shrink or remove Fordyce spots if cosmetic concerns arise. Fordyce spots may fade with time without any treatment, and it is crucial to avoid picking or squeezing them to prevent irritation or infection [3–5].

The AA, after having known that a hapless patient had undergone a surgical operation for excising a presumed tumor at the testicle, analised the possibility to create a cosmetic formula apt to scrab and abrade gently tese delicate spots in order to let the scrotum cushiony and smooth.

So the AA have recruited a young man (33 y. old) who was frightening to have a testicular cancer (with no evident signals and/or symptoms), because his companions playing rugby in the same team used to banter about a probable severe skin condition, when they showered toghether, and aware, the patient himself, to present a rheumatest value close to 10 and to be severely anxious.

The amalgam consisted in diverse antique ingredients even if simply retrievable in the market:

Tripoli salt ȃ 25; Diatoms ȃ 25; Baking soda ȃ 25; Reindeer fat ȃ 25.

The reindeer fat [7] has been chosen for the simplest fact that male reindeers do present the identical testosterone pool in their blood than humans.

This amalgam was to be spread three times/day onto the entire scrotum, and the volunteer had to wear a loincloth of hemp to be washed after the three applications of the amalgam every night.

The skin complicance did disappear after 9 days of applications of the amalgam: no substance could present the chamce to trespass the epidermal barrier of the scrotum and reach the blood stream.

REFERENCES

1. Rane V, Read T. Penile appearance, lumps and bumps. Aust Fam Physician. 2013;42:270-4.

2. Nyati A, Singh A, Mohta A, Kushwaha RK, Gupta D, Jain SK. A study of the pattern of non-venereal genital dermatoses in male patients at a Tertiary Care Centre from Hadoti region of Rajasthan. Our Dermatol Online. 2021;12:e87.

3. El Kadiri S, Bay Bay H, Douhi Z, Elloudi S, Mernissi FZ. Isolated lip lichen planus mimicking Fordyce hyperplasia. Our Dermatol Online. 2021;12:e58.

4. Sharquie K, Jabbar RI. Classifi cation and clinical evaluation of the types of angiokeratoma. Our Dermatol Online. 2021;12:130-4.

5. Bubenik GA, Schams D, White RJ, Rowell J, Blake J, Bartos L. Seasonal levels of reproductive hormones and their relationship to the antler cycle of male and female reindeer (Rangifer tarandus). Comp Biochem Physiol B Biochem Mol Biol. 1997;116:269-77.

6. Sarkar TK, Gupta N, Bandyopadhyay D, Bhargava S. Angiokeratoma circumscriptum neviforme:Extensive involvement of lower limb. Our Dermatol Online. 2020;11:403-5.

7. Hafi B, Uvais NA, Latheef EN, Razmi MT, Afra TP, Aysha S. Venereophobia –a cognitive deception?Case reports with literature review. Our Dermatol Online. 2020;11:e138.1-e138.5.