HistoryThis section has been translated automatically.
Fox and Fordyce, 1902
DefinitionThis section has been translated automatically.
Rare, inflammatory disease of the apocrine sweat glands, clinically characterized by skin-coloured or slightly reddish, intensely itchy papules attached to the sweat gland excretory ducts. The itching is intensified during physical exertion associated with sweating.
You might also be interested in
EtiopathogenesisThis section has been translated automatically.
Closure of the apocrine ducts by hyperkeratotic plug, congestion of secretion, rupture of the duct, secretion leakage into the periadnexal connective tissue, inflammatory reaction.
Family history suggests a genetic component.
ManifestationThis section has been translated automatically.
Almost exclusively (90%) female patients, postpubertal, premenstrual exacerbations. Improvement during pregnancy, under ovulation inhibitors or postmenopausal.
LocalizationThis section has been translated automatically.
Mainly axillary region, nipples, navel region, genital and perianal skin areas. Rarely perineum, navel, inner thighs.
Clinical featuresThis section has been translated automatically.
Grouped standing, pinhead-sized, flat or hemispherical, rough, skin-coloured to reddish, 0.2-0.3 cm large, protuberant nodules. Excruciating, localized itching. Localised sweating. Sparse underarm hair.
HistologyThis section has been translated automatically.
Closure of the excretory duct of the apocrine gland by a keratotic plug in the uppermost part of the hair follicle. Rupture of the sweat gland, formation of a spongiotic vesicle in the follicle wall (most likely visible in serial incisions). Inflammatory infiltrate in the surrounding dermis.
Differential diagnosisThis section has been translated automatically.
General therapyThis section has been translated automatically.
Treatment results are often unsatisfactory, a standard therapy does not exist. Listed treatment approaches are to be understood as therapy trials with very different success rates in individual cases. The invasiveness of the treatment should be proportionate to the clinical findings.
External therapyThis section has been translated automatically.
- Peeling treatment with 0.05%-0.1% vitamin A acid cream or ointment (e.g. Cordes VAS, R256 ) usually has a positive effect on itching and hair growth (less on the papules themselves) and should be the first choice therapy.
- Alternatively, partial successes with glucocorticoids as cream such as 0.5% hydrocortisone cream(Hydro-Wolff, R120 ) or 0.05-0.1% betamethasone cream(e.g. Betagalen, R029 ), methylprednisolone aceponate (Advantan cream), prednicarbate (Dermatop cream), tacrolimus or intralesional injections with triamcinolone acetonide (e.g. Volon A) are described.
- Alternatively, clindamycin in propylene glycol solution (e.g. Sobelin solution), UV light or electrocoagulation may be successful.
- Alternative: 1 publication proves success with local botulinum toxin applications.
- For the prevention of superinfections, local antibiotics such as tetracycline (e.g. Imex ointment) or erythromycin (e.g. acne mycin ointment).
Remember! Instead of Eucerin cum aqua Eucerin anhyd., Eucerin O/W- or W/O can be used as a basis for magisterial prescriptions.
Internal therapyThis section has been translated automatically.
In severe cases and in the absence of success with local therapy, contraceptives with antiandrogenic effects such as cyproterone acetate (e.g. Diane 35) or chlormadinone acetate (e.g. Gestamestrol N) can be tried.
Alternative: Retinoids like isotretinoin (e.g. isotretinoin-ratiopharm; acne normin) initial 0.5 mg/kg bw/day p.o. Reduction of the dose to the lowest possible maintenance dose according to the clinic. Long-term therapy is usually necessary because of recurrences on discontinuation.
Operative therapieThis section has been translated automatically.
In case of resistance to therapy or in severe cases, surgical measures may be necessary: excision of the affected areas with subsequent treatment with swivel valves or skin transplants leads to definitive healing.
Progression/forecastThis section has been translated automatically.
LiteratureThis section has been translated automatically.
- Bernad I et al (2014) FoxFordyce disease as a secondary effect of laser hair removal. J Cosmet Laser Ther 16:141-143
- Chae KM et al (2002) Axillary Fox-Fordyce disease treated with liposuction-assisted curettage. Arch Dermatol 138: 452-454
- Effendy I et al (1994) Fox-Fordyce disease in a male patient-response to oral retinoid treatment. Clin Exp Dermatol 19: 67-69
- Feldmann R et al (1992) Fox-Fordyce Disease: Successful Treatment with topical Clindamycin in alcoholic Propylene glycol solution. Dermatology 184: 310-313
- Fox GH, Fordyce JA (1902) Two cases of a rare papular disease affecting the axillary region. Journal of Cutaneous and Genitourinary Diseases (Chicago) 20: 1-5
- Ghislain PD et al (2002) Itchy papules of the axillae. Arch Dermatol 138: 259-264
- González-Ramos J et al (2016)Successful treatmeant of refractory pruritic Fox-Fordyce disease with botulinum toxin type A. Br J Dermatol 174: 458-459
- Hanner S et al. (2018) Axillary and perimamillary Fox Fordyce disease (apocrine miliaria) in a 19-year-old female patient Dermatologist 69: 313-315
- Kamada A et al (2003) Apoeccrine sweat duct obstruction as a cause for Fox-Fordyce disease. J Am Acad Dermatol 48: 453-455
- Mayser P et al (1993) Fox-Fordyce disease (Apocrine Miliaria). Dermatologist 44: 309-311
- Kaya Erdoğan H et al (2015) Clinical Effects of Topical Tacrolimus on Fox-Fordyce Disease. Case Rep Dermatol Med 2015:205418
Incoming links (13)Acanthosis circumporalis pruriens; Apocrine miliaria; Apocrinitis sudoripara pruriens; Betamethasone valerate cream hydrophilic 0.025/0.05 or 0.1% (nrf 11.37.); Deodorant granulomas; Fordyce, john addison; Hidradenoma eruptivum; Hydrocortisone cream 0.5-2.0% (w/o); Iridoneurodermite axillary audry; Pseudo-fox-fordyce's disease; ... Show all
Outgoing links (23)Antibiotics; Atopic dermatitis (overview); Betamethasone; Betamethasone valerate cream hydrophilic 0.025/0.05 or 0.1% (nrf 11.37.); Botulinum toxin a; Chloromadinone acetate; Clindamycin; Cyproterone acetate; Electrocoagulation; Erythromycin; ... Show all
Please ask your physician for a reliable diagnosis. This website is only meant as a reference.