Fox-Fordyce disease

Fox-Fordyce disease is an uncommon itchy eruption of the skin that appears where sweat glands are found. The causes of Fox-Fordyce disease are unknown. A keratin plug in the hair follicle obstructs sweat, and inflammation is the result, causing intense itching.

Fox-Fordyce disease has been reported after laser hair removal. There are two types of Fox-Fordyce disease: apocrine (follicular) type and apocrine (non follicular) type.

Heat, humidity, friction and stress appear to be exacerbating factors, though geographically, there doesn’t appear to be any one area or race that sees more Fox-Fordyce disease incidence.

Fox-Fordyce disease is far more common in women at a ratio of 9:1, with the age of onset usually between 13 and 35. It is rare before and after this age range.

Symptoms of Fox-Fordyce disease

• Intense itch that may disrupt sleep
• Possibly reduced sweating in that area
• Flesh-coloured bumps that may be reddish, smooth, dome-shaped
• Multiple papules on both sides
• Affects all follicles in one area
• Often in the armpits, but can affect pubic area, under breasts, or around the nipple (where Fordyce bumps are found)

What else could it be?

• Acneiform eruptions – acne-like skin eruptions
• Manifestations of miliaria (sweat duct blockage disease)
• Folliculitis (inflamed or infected hair follicle)
• Milia (benign, keratin-filled cysts)

Treatment of Fox-Fordyce disease

If the condition doesn’t resolve, the sweat glands may be removed using liposuction-assisted surgery. Surgical excision is not recommended. It is recommended to see a dermatologist.

Quality of life due to itching is the main concern. There is no loss of life or limb in this condition, however, treatments should focus on finding the cause and effectively treating it.

References

• Kamada A, Saga K, Jimbow K. Apocrine sweat duct obstruction as a cause for Fox-Fordyce disease. J Am Acad Dermatol. 2003 Mar. 48(3):453-5. [Medline].
• Lottge M, Flache K, Schrader C. [Case report of Fox-Fordyce disease]. Zentralbl Gynakol. 1988. 110(11):707-9. [Medline].