Fordyce spots masquerading as penile warts

Introduction

Fordyce spots are heterotopic sebaceous glands that can occur on the vermillion border of the lips, within the oral mucosa, on the penile shaft usually the ventral surface, scrotum, areolar region of the breast, and labia minora.¹ It was first described by John Addison Fordyce, an American dermatologist in 1896 and the condition is named after him.² Fordyce spots in the oral mucosa are very common. Especially when these occur on the male genitalia, usually after puberty, it is a matter of great concern for the patient and can at times confuse the untrained eye and appear like genital warts. Treatment is not necessary since it is an anatomical variation and a benign condition. However, for cosmetic reasons in a distressed patient, electrodessication, radiofrequency ablation, micro punch technique,³ or even laser ablation can be offered.⁴

Clinical findings and images

A 20-year-old male patient presented with complaints of multiple whitish growths on the inner aspect of his prepuce since one year. He gave history of an unprotected heterosexual penovaginal intercourse with an acquaintance a month prior to onset of lesions and attributed the lesions to the sexual exposure. There was no history of genital ulcer, urethral discharge, skin rash, or swelling in the groins associated with the lesions. General and systemic examination were unremarkable. Dermatological examination revealed multiple, discrete and confluent, whitish yellow, pinhead sized barely elevated papules with a glistening surface over the ventral aspect of the mucosal surface of the prepuce proximal to the frenulum (Fig. 1). A clinical diagnosis of Fordyce spots was made and the patient reassured. In view of the history of exposure and patient's apprehension of harboring a sexually transmitted disease, blood VDRL, HBSAg, anti HCV antibodies, and HIV antibodies were tested and found negative. With consent, a punch biopsy of the lesions was done which revealed ectopic sebaceous glands, consistent with a diagnosis of Fordyce spots (Fig. 2). The patient was reassured about the benign nature of his lesions and offered electrodessication of the lesions for cosmetic reasons which he declined once he was satisfied about the benign nature of his lesions.

Fig. 1.

Whitish yellow pinhead sized barely elevated papules on the ventral aspect of the mucosal surface of the prepuce. Patient's own hands seen in the photograph.

Fig. 2.

Punch biopsy revealing ectopic sebaceous glands in the dermis (H&E,10× magnification).

Conflicts of interest

The authors have none to declare.