Dermatology/lips and tongue


QUESTION: Good morning

i'm 32 italian, after pennicellina i started to have problems on my mouth, i used it 3 months ago...situation is going more bad....what are those things in the pics? i'm so worried and my girlfriend too....

thanks a lot


ANSWER: Fordyce spots, also known as Fordyce's spots, Fordyce granules or Sebaceous Prominence, are small raised, pale red, yellow-white or skin-colored bumps or spots that appear on the shaft of the penis, the labia, scrotum, or the vermilion border of the lips of a person's face. They can also be found on the foreskin of the penis (called Tyson's glands).

The vermilion (vermillion) border of the lips is the normally sharp demarcation between the red colored part of the lip and the adjacent normal skin of the face.

Fordyce Spots are named after the American dermatologist John Addison Fordyce (1858-1925) who first described them clinically in a medical journal. He also coined the terms Fox Fordyce disease, Fordyce's disease, Fordyce's lesion, and Brooke-Fordyce trichoepithelioma.

Fordyce Spots are common in both males and females.

Fordyce spots are a type of ectopic sebaceous gland:
Ectopic = in an abnormal location or position.
Sebaceous - fatty, greasy, adipose, fat - relating to oil and fat
Glands = organs or collection of cells that secrete things. Endocrine glands secrete things, such as hormones, into the body. Exocrine glands secrete things outside the body, such as sweat or mucus.
Sebaceous gland = a small skin gland that secretes sebum (oily matter) into the hair follicles to lubricate the hair and skin
Ectopic sebaceous gland = a sebaceous gland that is on the skin but not in the hair follicle.
According to Medilexicon's medical dictionary, Fordyce spots are:

"A condition marked by the presence of numerous small, yellowish-white bodies or granules on the inner surface and vermilion border of the lips; histologically the lesions are ectopic sebaceous glands."

Although Fordyce Spots are sebaceous glands which are in "the wrong place" (not in hair follicles), they are not associated with any disease or illness. Dermatologists say they are of cosmetic concern only - people who have them might not be happy with how they affect the way they look.

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QUESTION: Thanks for the quick answer, in this case fordyce spots don't need treatments right? but about the rashes on my tongue? it comes out after pennicellina and from months i have this disturb. i'm really depressed about this :(

Fordyce spots do not need to be treated as they are normal. The lesions on your tongue are aphthous ulcers.

The etiology of recurrent aphthous stomatitis (RAS) is not entirely clear, and aphthae are therefore termed idiopathic. RAS may be the manifestation of a group of disorders of quite different etiology, rather than a single entity.

Despite many studies trying to identify a causal microorganism, RAS does not appear to be infectious, contagious, or sexually transmitted. Immune mechanisms appear at play in persons with a genetic predisposition to oral ulceration.

A genetic basis exists for some RAS. This is shown by a positive family history in about one third of patients with RAS, an increased frequency of HLA types A2, A11, B12, and DR2, and susceptibility to RAS which segregates in families in association with HLA haplotypes. RAS probably involves cell-mediated mechanisms, but the precise immunopathogenesis remains unclear. Phagocytic and cytotoxic T cells probably aid in destruction of oral epithelium that is directed and sustained by local cytokine release.

Patients with active RAS have an increased proportion of gamma-delta T cells compared with control subjects and patients with inactive RAS. Gamma-delta T cells may be involved in antibody-dependent cell-mediated cytotoxicity (ADCC). Compared with control subjects, individuals with RAS have raised serum levels of cytokines such as interleukin (IL)–6 and IL-2R, soluble intercellular adhesion modules (ICAM), vascular cell adhesion modules (VCAM), and E-selectin; however, some of these do not correlate with disease activity.

Cross-reactivity between a streptococcal 60- to 65-kd heat shock protein (hsp) and the oral mucosa has been demonstrated, and significantly elevated levels of serum antibodies to hsp are found in patients with RAS. Lymphocytes of patients with RAS have reactivity to a peptide of Mycobacterium tuberculosis. Some cross-reactivity exists between the 65-kd hsp and the 60-kd human mitochondrial hsp. Monoclonal antibodies to part of the 65-kd hsp of M tuberculosis react with Streptococcus sanguis. RAS thus may be a T cell–mediated response to antigens of S sanguis, which cross-react with the mitochondrial hsp and induce oral mucosal damage. RAS patients have an anomalous activity of the toll-like receptor TLR2 pathway that probably influences the stimulation of an abnormal Th1 immune response.

Predisposing factors found may include any of the following:

Hematinic deficiency: Up to 20% of patients are deficient of iron, folic acid (folate), or vitamin B.
Malabsorption in gastrointestinal disorders: About 3% of patients experience these disorders, particularly celiac disease (gluten-sensitive enteropathy) but, occasionally, Crohn disease, pernicious anemia, and dermatitis herpetiformis. HLA DRW10 and DQW1 may predispose patients with celiac disease to RAS.
Cessation of smoking: This may precipitate or exacerbate RAS in some cases.
Stress: This underlies RAS in some cases; ulcers appear to exacerbate during school or university examination times.
Trauma: Biting of the mucosa and wearing of dental appliances may lead to some ulcers; RAS is uncommon on keratinized mucosae.
Endocrine factors in some women: RAS is clearly related to the progestogen level fall in the luteal phase of the menstrual cycle, and ulcers may then temporarily regress in pregnancy.
Allergies to food: Food allergies occasionally underlie RAS; the prevalence of atopy is high. Patients with aphthae may occasionally have a reaction to cow's milk, and may have been weaned at an early age.
Sodium lauryl sulphate (SLS): This is a detergent in some oral healthcare products that may aggravate or produce oral ulceration.
Immune deficiencies: Ulcers resembling RAS (aphthouslike ulcers) may be seen in patients with HIV, neutropenias, and some other immune defects.
Drugs, especially NSAIDs, alendronate, and nicorandi. These may produce mouth ulcers, but the history should distinguish them from RAS.


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Michael S. Fisher, <B>Ph.D., M.D.</B>


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