PEDIATRIC DERMATOLOGY
WHAT'S YOUR Dx?
Yellow bumps on the lips: What do they say to you?
By Bernard Cohen, MD
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A 16-year-old boy visits your office complaining of yellow bumps on his upper lip. He first noticed them six months ago. And he tells you that he doesn't want to leave the country for a planned high school semester abroad with these "funny bumps," as he calls them.
Your patient is healthy, and his growth and development have been normal. The lesions are asymptomatic, and the rest of his cutaneous and medical examination is normal. Neither his parents nor his siblings, he reports, have similar lesions.
Diagnosis: Fordyce granules (spots)
The small, uniform size and superficial anatomic location of the papules, which do not disrupt the epidermal markings, are typical of Fordyce granules (spots), also known as ectopic sebaceous glands. The yellow hue of these lesions provides a clue to the diagnosis.
Characteristics. Fordyce granules are the most common structural anomaly in the mouth. Initially described by von Kolliker in 1861, the lesion was named later for John Addison Fordyce, who wrote about them in 1896.1
Fordyce spots are most often found on the lips as tiny yellow papules. Occasionally, they coalesce to form larger, asymptomatic plaques. The buccal mucosa is another common site (see Figure); occasionally, they develop on the tongue, gingivae, frenulum, and palate.
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The granules are probably present at birth, but they do not become clinically evident until sometime in puberty.2,3 Fordyce granules are found in 20% of children, 30% of adolescents, and 70% to 80% of adults. They may become subtle or disappear altogether in old age.
Biopsy reveals normal sebaceous glands; the granules are not associated with hair follicles.
Treatment is usually unnecessary. If the patient finds them objectionable, superficial carbon dioxide laser ablation removes cosmetically disfiguring lesions.
Differential diagnosis. Warts and molluscum contagiosum may be confused with Fordyce granules because both can involve the vermillion border. Unlike Fordyce granules, however, these two conditions produce papules that disrupt normal epidermal markings. Accessory salivary glands—another look-alike—usually appear as small papules in the submucosa of the intraoral aspect of the lip. Mucoceles present as glistening papulovesicles 3 mm to 1 cm in diameter that appear on the inside of the lower lip.
Resolution. The patient's upper lip was treated with superficial carbon dioxide laser ablation. Within seven days, the area had healed and the lesions were completely eradicated, leaving no scarring.
| The next installment of Pediatric Dermatology: What's your Dx? will appear in April 2004. |
REFERENCES
1. Fordyce JA: A peculiar affection of the mucous membrane of the lips and oral cavity. Journal of Cutaneous and Genitourinary Diseases 1896;14:413
2. Daley TD: Pathology of intraoral sebaceous glands. J Oral Pathol Med 1993;22:241
3. Daley TD: Intraoral sebaceous hyperplasia. Diagnostic criteria. Oral Surg Oral Pathol 1993;75:343
DR. COHEN, who serves as section editor for Pediatric Dermatology: What's your Dx?, is director, Pediatric Dermatology and Cutaneous Laser Center, and associate professor of pediatrics and dermatology at Johns Hopkins University School of Medicine, Baltimore. He is a contributing editor for Contemporary Pediatrics.
Bernard Cohen. Pediatric dermatology: What's your Dx? Contemporary Pediatrics January 2004;21:35.
