ABSTRACT
Background:
Fordyce granules, sometimes referred to as Fordyce dots, are aberrant sebaceous glands that present as diminutive, non-painful, elevated lesions exhibiting a yellowish or whitish hue, measuring 1 to 3 mm in diameter, and manifesting inside the oral cavity. Likewise, these particles may also be seen in the vaginal region and inside the oral cavity.
Aim:
The primary objective of the current study is to evaluate the potential association between Fordyce granules and the skin type of individuals who seek dental care at the Dental Clinics of Qassim University.
Materials and Methods:
The current cross-sectional research was undertaken at the Dental Clinics of Qassim University, with a sample of 87 patients diagnosed with Fordyce’s granules. The research consisted of a heterogeneous sample of participants, including individuals of all genders, ranging in age from 18 to 85 years. The study included a comprehensive evaluation of several anatomical regions to identify the existence of Fordyce’s granules. This examination was conducted by a single examiner who had undergone calibration. Additionally, the participants’ skin types were established using the Baumann Skin Typing System questionnaire. The data that was gathered was afterward analyzed utilizing statistical methods via the use of SPSS software. A pre-set significance level was established at P < 0.05.
Results:
The distribution of skin types among the study participants with Fordyce’s granules were found to be oily skin (51.3%), dry skin (47.9%), sensitive skin (49.3%), and resistant skin (56.3%). The results of the research showed that there was no statistically significant correlation between the two variables, i.e. skin type and the presence of Fordyce’s granules. This conclusion is supported by the increased P values of 0.941 for those with oily skin and 0.785 for individuals with dry skin.
Conclusion:
No relation between skin type and Fordyce’s granules in the current study.
KEYWORDS: Dermis, Fordyce’s granules, oral mucosa, pathology, sebaceous glands
INTRODUCTION
Fordyce granules, also described as Fordyce dots, are ectopic sebaceous glands. These glands are characterized by their tiny size, lack of discomfort, elevated appearance, and yellowish or white hue. They typically measure from 1 to 3 mm in diameter and are seen inside the oral cavity.[1] Likewise, similar granules may be seen in the genital region and oral mucosa, often manifesting as yellowish-white patches or milky spots. Fordyce granules are often seen along the vermillion border and lips, which are well recognized as prominent locations for their occurrence.[2] The investigation of Fordyce granules and their correlation with patient characteristics, including skin type, age, and gender, is a research area of significant scientific importance.
Determining the prevalence and distribution of Fordyce granules among different patient populations can contribute to the enhancement of clinical practice. This knowledge empowers healthcare professionals to offer appropriate counselling and reassurance to affected patients. Furthermore, investigating the underlying mechanisms behind the formation of Fordyce granules can provide valuable insights into the pathophysiology of ectopic sebaceous gland disorders.[3] By studying the factors that influence the prevalence and distribution of these granules, it may be possible to identify common pathways or mechanisms that contribute to the development of similar lesions, paving the way for more pathophysiological understanding and potential therapeutic strategies. Since the pathogenesis of Fordyce granules remains uncertain, understanding the factors that influence their formation is of utmost importance for future research in this field.[4]
While there is a lack of studies analyzing the association between Fordyce granules and skin type, a study conducted by Baharvand et al.[5] demonstrated a significantly higher prevalence of Fordyce granules in individuals with Fitzpatrick skin types IV–VI (62.9%) compared to those with skin types I–III (28.8%), which suggests that individuals with darker skin types may be prone to develop Fordyce granules compared to those with hypopigmented skin. However, A case report in Japan and Saudi Arabia found a relation between the hypopigmentation presence of Fordyce’s granules. There is emerging evidence suggesting a potential link between hypopigmentation of the skin and the occurrence of Fordyce granules.[5] This finding may be coincident since Fordyce’s granule is a common finding.[6] The aim of this study was to investigate the association between Fordyce granules and skin type among individuals seeking dental treatment at the Dental Clinics situated at Qassim University in Qassim, Saudi Arabia.
MATERIALS AND METHODS
The current cross-sectional study was done on a sample of 87 patients attending Qassim University’s Dental Clinics from January 2023 to March 2023. Ethical approval was obtained from the ethics committee of the dental section of Qassim University and the participants acquiesced to taking part in the research. The research involved two distinct cohorts of individuals. The first group is people with Fordyce’s granules. The other group is people without discernible Fordyce’s granules. Every participant included in the study was given a questionnaire to determine their skin type. The test was conducted by a solitary examiner who had been calibrated, using a mouth mirror and ensuring sufficient light. Clinically, they look like tiny, painless, elevated areas with a yellowish or white coloration, measuring 1 to 3 mm in diameter, appearing in different sites of oral cavity, varying in amounts from a few dispersed granules to sheets covering the affected mucosa. These granules were diagnosed clinically by an oral pathologist (FA).
The clinical examination included the assessment of many anatomical areas, including the upper and lower lips, buccal mucosa, vermilion border, retromolar region, and gingiva, in order to recognize the presence of Fordyce’s granules. The collection of information on skin type was conducted via the use of “The Baumann Skin Typing System (BSTS),” which was created in 2004. This approach further differentiates depending on pigmentation, wrinkles, and absence thereof. It categorizes skin into four separate groups: dry, oily, sensitive, and resistant. The BSTS, which is based on a scientifically verified questionnaire, assists healthcare professionals and individuals in choosing the most appropriate drugs and skincare products by taking into account many contemporaneous cutaneous factors and collecting historical data. Based on the provided responses, the questionnaire assigns a distinct skin type code, which encompasses a range from dry (D) to oily (O) and from sensitive (S) to resistant (R). The questionnaire evaluates how the skin responds in a variety of circumstances, allowing for the collection of historical data as well as information about the current state of the skin. The use of this fundamental questionnaire may effectively assess skin oiliness in several contexts such as screening and recruiting study participants for trials, conducting outcome research, and providing recommendations for skin care products and treatments. The “Statistical Package for the Social Sciences (SPSS),” version 17, was used to examine the information gathered. When using the Chi-square test, a significance level of P < 0.05 was regarded as statistically significant.
RESULTS
The study included 87 participants, divided into five age groups, most of whom were 21–30 years old [Table 1]. About 45 cases showed Fordyce’s granules, and out of these 45 cases, 28 (62.2%) had Fordyce’s granules on the lips, 10 (22.22%) on the inner part of the mouth, and 7 (15.5%) on both the lips and inner part of the mouth. There was a relatively equal distribution of the presence of Fordyce’s granules across different skin types, with a slightly higher presence in individuals with oily (51.3%) and resistant skin (56.3%) compared to individuals with dry (47.9%) and sensitive skin (49.3%) [Table 2]. The results of the investigation showed that there was no statistically significant relationship between skin type and Fordyce’s granule presence [Table 2]. Table 3 shows the correlation between the presence of Fordyce’s granules and two skin types, OD (oily skin) and SR (sensitive skin). The Pearson correlation coefficients are 0.008 and 0.043, respectively, indicating a very weak positive correlation [Table 4]. It was observed that males had a significantly higher prevalence of Fordyce’s granules compared to females (P = 0.049) [Table 3].
Table 1.
Distribution of presence of Fordyce’s granules according to age groups
| Presence of Fordyce’s granules | Age Groups | Total | χ 2 | P | ||||
|---|---|---|---|---|---|---|---|---|
|
| ||||||||
| 10–20 years | 21–30 years | 31–40 years | 41–50 years | >50 years | ||||
| Absent | 0 (0.0%) | 40 (52.6%) | 0 (0.0%) | 1 (100.0%) | 1 (33.3%) | 42 (48.3%) | 8.450 | 0.076 |
| Present | 3 (100.0%) | 36 (47.4%) | 4 (100.0%) | 0 (0.0%) | 2 (66.7%) | 45 (51.7%) | ||
| Total | 3 (100.0%) | 76 (100.0%) | 4 (100.0%) | 1 (100.0%) | 3 (100.0%) | 87 (100.0%) | ||
Table 2.
Comparison of presence of Fordyce’s granules according to skin type
| Presence of Fordyce’s granules | O Skin | D skin | S Skin | R Skin |
|---|---|---|---|---|
| Absent | 19 (48.7%) | 23 (47.9%) | 35 (49.3%) | 7 (43.8%) |
| Present | 20 (51.3%) | 25 (52.1%) | 36 (50.7%) | 9 (56.3%) |
| Total | 39 (100.0%) | 48 (100.0%) | 71 (100.0%) | 16 (100.0%) |
| χ 2 | 0.006a | 0.161 | ||
| P | 0.941 | 0.785 | ||
Table 3.
Distribution of presence of Fordyce’s granules according to gender
| Presence of Fordyce’s granules | Male | Female | Total | χ 2 | P |
|---|---|---|---|---|---|
| Absent | 20 (39.2%) | 22 (61.1%) | 42 (48.3%) | 4.052 | 0.05 |
| Present | 31 (60.8%)* | 14 (38.9%) | 45 (51.7%) | ||
| Total | 51 (100.0%) | 36 (100.0%) | 87 (100.0%) |
Table 4.
Correlation of presence of Fordyce’s granules according to skin type
| Do you have a Fordyce’’ Granules? | OD | SR | |
|---|---|---|---|
| Do you have Fordyce’s granules? | |||
| Pearson correlation | 1 | 0.008 | 0.043 |
| P | 0.942 | 0.693 | |
| N | 87 | 87 | 87 |
DISCUSSION
The literature shows a lack of studies that correlate Fordyce’s granules with different skin types. This research examined the relationship between Fordyce’s granules and different skin types in patients who come to routine dental care at Qassim University Dental Clinics. In recent years, there has been a growing interest in dermatological research on the correlation between Fordyce granules and skin type. Some studies have explored whether certain skin types are more prone to the development or prevalence of Fordyce granules.[7,8] Understanding the association between Fordyce granules and skin type can provide insights into their pathogenesis and clinical significance. The current study was conducted in the Dental Clinics at Qassim University, Qassim, Saudi Arabia. The granules were diagnosed clinically by an oral pathologist (FA). The research findings indicate a slightly higher occurrence of Fordyce’s granules in males than females, which contradicts the outcomes of previous studies by Chuong et al.[9] and dos Santos et al.[10] Concerning age cohorts, the present investigation observed an increased prevalence of Fordyce’s granules among persons aged 21–30 years and 31–40 years. The findings of this investigation are consistent with the research carried out by Gabin et al., which also documented a greater occurrence of the phenomenon among persons of a younger age.[11] The lack of significant associations between age groups and Fordyce’s granules aligns with the study conducted by Garbin et al.[11] However, other studies have reported conflicting results. For instance, a study by Gaballah and Rahimi[12] found a higher prevalence of Fordyce’s granules among older individuals. The aforementioned inconsistencies underscore the need for more investigation in order to elucidate the correlation between age and the occurrence of Fordyce’s granules. However, the absence of a significant association between age groups and Fordyce’s granules in the current study suggests that age alone may not be a determining factor for the presence of these granules.
In terms of skin type, the current study found a relatively equal distribution of Fordyce’s granules across different skin types, with a nonsignificant higher presence in individuals with oily or resistant skin. This finding is in contrast with another study that reported a significant association between Fordyce’s granules and dry skin.[13] These discrepancies may be attributed to variations in sample characteristics and geographic location, highlighting the need for further investigation in diverse populations. The study’s findings regarding gender are consistent with the work of Chuong et al.[9] and dos Santos et al.[10] Regarding the association between skin type and Fordyce’s granules, the current study’s findings are not consistent with the significant association reported by Pietkiewicz et al.[14] This discrepancy may be attributed to variations in sample characteristics, measurement methods, or geographical factors.
De Felice et al.[15] conducted an assessment of the correlation between Fordyce’s granules and “hereditary nonpolyposis colorectal cancer syndrome” (HNPCC). The researchers conducted an investigation on individuals from five distinct HNPCC families that were not genetically connected. It is noteworthy that a positive correlation has been discovered between Fordyce’s Granules and Hereditary Nonpolyposis Colorectal Cancer (HNPCC). The predominant manifestation of hereditary colorectal cancer (CRC) is hereditary nonpolyposis colorectal cancer syndrome (HINPCC), often known as Lynch syndrome.[16,17] This observation suggests that Fordyce’s Granules may serve as a potential tool for predicting potential illnesses.
The main limitation of the current study is the small sample size as well as the too-long survey filled out by participants to determine the skin type. A larger sample size with clinical-based skin type detection in coordination with a dermatologist would provide a more concise and representative correlation. Also, the current study was conducted in a single population in a single geographic area. A similar study conducted in different populations would give an understanding of Fordyce’s granules with different skin types.
CONCLUSION
The majority of participants were in the 21–30 age range. Fordyce’s granules were observed in 45 cases, with varying distributions on the lips, inner part of the mouth, or both. The study found a relatively equal distribution of Fordyce’s granules across different skin types, with a slightly higher prevalence in individuals with oily and resistant skin. This study contributes valuable insights into the distribution of Fordyce’s granules and their correlation with specific skin types, emphasizing the need for continued research to deepen our understanding of these dermatological findings.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgment
Researchers would like to thank the Deanship of Scientific Research, Qassim University for funding the publication of this project. Also, we would like to express our gratefulness to Dr. Rahul Gaikwad, assistant professor of community dentistry, College of Dentistry, Qassim University for his assistance in the statistical analysis for this paper.
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