Foxâ€"Fordyce disease, or apocrine miliaria, is a chronic blockage of the sweat gland ducts with a secondary, non-bacterial inflammatory response to the secretions and cellular debris in the cysts. Hidradenitis is very similar, but tends to have a secondary bacterial infection so that pus-draining sinuses are formed. It is a very devastating skin disease that does not have universally curative treatments. Many that have this disease avoid sweat-inducing activities and prefer swimming as their mode of exercise.
Presentation
The apocrine glands (sweat glands) are the site of the Foxâ€"Fordyce disease. Lesions can be found at the sweat glands in addition to periareolar, inframammary and pubic areas. Lesions can be any shape (smooth, dome-shaped, etc.) and range from flesh-colored to red and sweating is often absent in the areas that are affected. Hair follicles can become damaged as well and can result in hair loss in the affected area.
Treatment
The mainstay treatment is surgical removal of the skin tissue containing affected sweat glands. Irradiation therapy may also be used and antibiotics are used to reduce the inflammatory response. In women, many patients improved when they were placed on an oral contraceptive birth control (high levels of estrogen or testosterone for men). Other treatments include topical steroids and ointments, dermabrasion, and ultraviolet light. Typically these treatments did not cure the disease and were deemed by many patients as intolerable.
Antibiotics used: Clindamycin topical, Erythromycin. Both inhibit bacterial growth and are used when treating staphylococcal and streptococcal infection.
No treatment is required for Fordyce granules, except for cosmetic removal of labial lesions. Inflamed glands can be treated topically with clindamycin. When surgically excised, there is no recurrence. Neoplastic transformation is very rare but has been reported.
Epidemiology
Although Foxâ€"Fordyce disease is relatively uncommon in the United States, it is exacerbated by heat, humidity, and areas of friction (arm pits), thus it is more prevalent in tropic-like conditions. There is no loss of life or limb related to this disease, but irritations do occur, especially at night. Pruritus is defined by Medscape as an "unpleasant sensation that provokes the desire to scratch" and it will typically disturb the sleep of the patient. It does occur in women more than men: female-to-male ratio of 9:1 and most commonly affects women aged 13â€"35 years, approximately puberty through their prime.
Eponym
It is named for George Henry Fox and John Addison Fordyce.
See also
- List of cutaneous conditions
References
Further reading
- Fox-Fordyce Disease at eMedicine