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Fox-Fordyce Disease Clinical Presentation

  • Author: Christopher R Gorman, MD; Chief Editor: William D James, MD  more...
 
Updated: Sep 23, 2015
 

History

Fox-Fordyce disease frequently appears under conditions of heat, humidity, and friction, often appearing suddenly. Many patients present after decades of symptoms.

Few patients are asymptomatic. Most patients relate pruritus that disturbs sleep.

Changing antiperspirants has not been reported to help. Some patients report diminution of sweating after the onset of symptoms.

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Physical

The apocrine glands are the site of Fox-Fordyce disease. Lesions are most often found in the axillae, where they tend to be bilateral. Lesions may also affect the periareolar, inframammary, and pubic areas.

The primary lesion is a flesh-colored to reddish, smooth, dome-shaped, discrete, and follicular or perifollicular papule. Affected areas usually have many papules. The papules usually appear to affect every follicle in a given area. Excoriations and lichenification may be seen as a consequence of scratching.

Sweating is often absent in the affected area.

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Causes

The definite increased prevalence of Fox-Fordyce disease in women has led to an unproved theory of hormonal influences. Reports of cases of Fox-Fordyce disease in prepubertal girls are evidence against the hormonal theory. The exact pathophysiology is still unknown.

A number of factors, including (1) emotional and/or hormonal influences and (2) alterations in sweat components, have been implicated in Fox-Fordyce disease.

Fox-Fordyce disease has been reported to occur after laser hair removal.[5, 6, 7]

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Contributor Information and Disclosures
Author

Christopher R Gorman, MD Avenues Dermatology, Private Practice

Christopher R Gorman, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Specialty Editor Board

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Texas Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Chief Editor

William D James, MD Paul R Gross Professor of Dermatology, Vice-Chairman, Residency Program Director, Department of Dermatology, University of Pennsylvania School of Medicine

William D James, MD is a member of the following medical societies: American Academy of Dermatology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Acknowledgements

Mary Farley, MD Dermatologic Surgeon/Mohs Surgeon, Anne Arundel Surgery Center

Disclosure: Nothing to disclose.

References
  1. Fox G, Fordyce J. Two cases of a rare papular disease affecting the axillary region. J Cutan Genito-Urinary Dis. 1902. 20:1-5.

  2. Shelley WB, Levy EJ. Apocrine sweat retention in man. II. Fox-Fordyce disease (apocrine miliaria). AMA Arch Derm. 1956 Jan. 73(1):38-49. [Medline].

  3. Ranalletta M, Rositto A, Drut R. Fox-Fordyce disease in two prepubertal girls: histopathologic demonstration of eccrine sweat gland involvement. Pediatr Dermatol. 1996 Jul-Aug. 13(4):294-7. [Medline].

  4. Kamada A, Saga K, Jimbow K. Apoeccrine sweat duct obstruction as a cause for Fox-Fordyce disease. J Am Acad Dermatol. 2003 Mar. 48(3):453-5. [Medline].

  5. Helou J, Maatouk I, Moutran R, Obeid G. Fox-Fordyce-like disease following laser hair removal appearing on all treated areas. Lasers Med Sci. 2013 Jan 15. [Medline].

  6. Alés-Fernández M, Ortega-Martínez de Victoria L, García-Fernández de Villalta MJ. Lesions in the axilla after hair removal using intense pulsed light. Fox-Fordyce disease. Actas Dermosifiliogr. 2015 Jan-Feb. 106 (1):61-2. [Medline].

  7. Bernad I, Gil P, Lera JM, Giménez de Azcárate A, Irarrazaval I, Idoate MÁ. Fox Fordyce disease as a secondary effect of laser hair removal. J Cosmet Laser Ther. 2014 Jun. 16 (3):141-3. [Medline].

  8. Stashower ME, Krivda SJ, Turiansky GW. Fox-Fordyce disease: diagnosis with transverse histologic sections. J Am Acad Dermatol. 2000 Jan. 42 (1 Pt 1):89-91. [Medline].

  9. Bormate AB Jr, Leboit PE, McCalmont TH. Perifollicular xanthomatosis as the hallmark of axillary Fox-Fordyce disease: an evaluation of histopathologic features of 7 cases. Arch Dermatol. 2008 Aug. 144(8):1020-4. [Medline].

  10. Macarenco RS, Garces S JC. Dilation of apocrine glands. A forgotten but helpful histopathological clue to the diagnosis of axillary Fox-Fordyce disease. Am J Dermatopathol. 2009 Jun. 31(4):393-7. [Medline].

  11. Miller ML, Harford RR, Yeager JK. Fox-Fordyce disease treated with topical clindamycin solution. Arch Dermatol. 1995 Oct. 131(10):1112-3. [Medline].

  12. George A, Bhatia A, Thomas E. Fox-Fordyce disease: a report of 2 cases responding to topical clindamycin. Indian J Dermatol Venereol Leprol. 2015 Jan-Feb. 81 (1):87-8. [Medline].

  13. Chae KM, Marschall MA, Marschall SF. Axillary Fox-Fordyce disease treated with liposuction-assisted curettage. Arch Dermatol. 2002 Apr. 138 (4):452-4. [Medline].

  14. Pock L, Svrckova M, Machackova R, Hercogova J. Pimecrolimus is effective in Fox-Fordyce disease. Int J Dermatol. 2006 Sep. 45(9):1134-5. [Medline].

  15. Kaya Erdoğan H, Bulur I, Kaya Z. Clinical Effects of Topical Tacrolimus on Fox-Fordyce Disease. Case Rep Dermatol Med. 2015. 2015:205418. [Medline].

  16. Brau Javier CN, Morales A, Sanchez JL. Histopathology attributes of Fox-Fordyce disease. Int J Dermatol. 2012 Nov. 51(11):1313-8. [Medline].

  17. Milcic D, Nikolic M. Clinical effects of topical pimecrolimus in a patient with Fox-Fordyce disease. Australas J Dermatol. 2012 May. 53(2):e34-5. [Medline].

  18. Yost J, Robinson M, Meehan SA. Fox-Fordyce disease. Dermatol Online J. 2012 Dec 15. 18(12):28. [Medline].

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