Fordyce spots, also known as Fordyce granules or sebaceous prominence, are benign ectopic sebaceous glands commonly found on the genitalia, including the penis. While Fordyce spots are harmless and do not require treatment, some individuals may seek medical intervention for cosmetic reasons or psychological distress. Here is summary of my experience in managing this common condition.
Topical Fordyce Spots Treatments:
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- Tretinoin Cream: Topical tretinoin, a retinoid compound, has been reported as a potential treatment option for Fordyce spots. Tretinoin works by promoting cellular turnover and reducing sebaceous gland size. Though it can be effective in small studies, the actual chances of this working is slim.
- Cryotherapy: Cryotherapy involves freezing the Fordyce spots using liquid nitrogen. This method aims to destroy the affected tissue and stimulate the growth of healthy skin. Cryotherapy has shown variable results, with some reports indicating partial improvement, while others suggest minimal effect. It may be associated with side effects such as blistering, pain, or hypopigmentation. It is still performed by some GPs. Lasers offer more precise targeting of spots.
- Electrodessication: Electrodessication involves the use of an electric needle or probe to destroy the Fordyce spots. This method aims to remove or cauterize the affected tissue. This technique is done in third world countries who do not have access to lasers. Punch excision has been reported.
- CO2 Laser Ablation: Carbon dioxide (CO2) laser ablation is a procedure that utilizes laser energy to vaporize or remove the affected tissue. Studies have reported successful outcomes with CO2 laser treatment, demonstrating improvement in the appearance of Fordyce spots. It offers the best solution for Fordyce spots as it has minimal collateral damage & maximal precision. 1-2 sessions are required for best results.
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Conclusion:
The treatment of Fordyce spots on the penis is primarily driven by cosmetic concerns or psychological distress experienced by individuals. Currently, there is no universally effective treatment for Fordyce spots, and the available options have variable success rates. Topical treatments like tretinoin may show some promise, but further research is needed. Surgical interventions such as CO2 laser ablation and electrodessication have demonstrated favorable outcomes in select cases, but their efficacy and safety should be considered on an individual basis. It is important for healthcare professionals to discuss the potential risks, benefits, and limitations of each treatment option with patients, considering their specific circumstances, preferences, and expectations.
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Prevention is best achieved with oral isotretinoin therapy at a low dose of between 5 to 10 mg daily. The risk benefit ratio will be discussed by your treating dermatologist.
Disclaimer: I do not manage or diagnose genital disorders, including Fordyce spots. My colleague, Dr Sarath at Cutis Dermatology, Brisbane has an interest in male genital dermatology.
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