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Fox-Fordyce Disease Workup

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

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.[8]

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.

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Procedures

In 2002, Chae et al described axillary Fox-Fordyce disease treated with liposuction-assisted curettage.

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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.[9]  Perifollicular xanthomatosis may result in a histologic misdiagnosis of planar xanthoma due to sectioning error (author). Apocrine acini dilation may be another helpful nonspecific histologic finding.[10]

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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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