Laboratory Studies
- Histopathologic diagnosis of Fox-Fordyce disease may be very difficult with conventional sectioning. Stashower et al proposed transverse histologic sectioning as the most effective way to demonstrate diagnostic features.[6]
- Diagnosis of Fox-Fordyce disease is usually made on clinical/historical grounds. Laboratory or even histopathologic tests are seldom necessary for clinicians familiar with this condition.
Procedures
- In 2002, Chae et al described axillary Fox-Fordyce disease treated with liposuction-assisted curettage.[7]
Histologic Findings
The proposed apocrine origin of Fox-Fordyce disease was based on the finding of a keratin plug in the follicular infundibulum that occluded the apocrine acrosyringium. Reports also include a rupture of the apocrine duct and a resulting spongiotic inflammation. Plasma cells may be noted, and the deeper apocrine duct may be dilated with sialomucin. The dermis may show fibrosis and chronic inflammation. These latter findings depend on the condition's chronicity.
Transverse sectioning may allow for a more accurate diagnosis of Fox-Fordyce disease. Bormate et al contend that perifollicular xanthomatosis (foam cells) is a specific, relatively consistent, and distinct histologic feature in 7 cases.[8] Apocrine acini dilation may be another helpful nonspecific histologic finding.[9]
Fox G, Fordyce J. Two cases of a rare papular disease affecting the axillary region. J Cutan Genito-Urinary Dis. 1902;20:1-5.
Shelley WB, Levy EJ. Apocrine sweat retention in man. II. Fox-Fordyce disease (apocrine miliaria). AMA Arch Derm. Jan 1956;73(1):38-49. [Medline].
Ranalletta M, Rositto A, Drut R. Fox-Fordyce disease in two prepubertal girls: histopathologic demonstration of eccrine sweat gland involvement. Pediatr Dermatol. Jul-Aug 1996;13(4):294-7. [Medline].
Kamada A, Saga K, Jimbow K. Apoeccrine sweat duct obstruction as a cause for Fox-Fordyce disease. J Am Acad Dermatol. Mar 2003;48(3):453-5. [Medline].
Sandhu K, Gupta S, Kanwar AJ. Fox fordyce disease in a prepubertal girl. Pediatr Dermatol. Jan-Feb 2005;22(1):89-90. [Medline].
Stashower ME, Krivda SJ, Turiansky GW. Fox-Fordyce disease: diagnosis with transverse histologic sections. J Am Acad Dermatol. Jan 2000;42(1 Pt 1):89-91. [Medline].
Chae KM, Marschall MA, Marschall SF. Axillary Fox-Fordyce disease treated with liposuction-assisted curettage. Arch Dermatol. Apr 2002;138(4):452-4. [Medline].
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. Aug 2008;144(8):1020-4. [Medline].
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. Jun 2009;31(4):393-7. [Medline].
Effendy I, Ossowski B, Happle R. Fox-Fordyce disease in a male patient--response to oral retinoid treatment. Clin Exp Dermatol. Jan 1994;19(1):67-9. [Medline].
Miller ML, Harford RR, Yeager JK. Fox-Fordyce disease treated with topical clindamycin solution. Arch Dermatol. Oct 1995;131(10):1112-3. [Medline].
Pock L, Svrckova M, Machackova R, Hercogova J. Pimecrolimus is effective in Fox-Fordyce disease. Int J Dermatol. Sep 2006;45(9):1134-5. [Medline].
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