Fox-Fordyce Disease Clinical Presentation

Updated: Aug 14, 2017
  • Author: Christopher R Gorman, MD; Chief Editor: William D James, MD  more...
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Presentation

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 Examination

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, 8]

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Complications

Manage Fox-Fordyce disease complications (eg, local superinfection) in the standard ways.

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