By Gary M. White, MD
Fox-Fordyce disease (FFD) is an uncommon chronic follicular-based papular dermatosis confined to apocrine gland-bearing skin. It is caused by keratin plugging of the follicular infundibulum at the distal portion of the apocrine sweat duct and less often by plugging of apoeccrine ducts. This obstruction causes apocrine sweat retention and, over time, rupture of glands with secondary inflammation.
Uniformly distributed, pruritic, flesh-colored papules in the axilla, areola, groin, and perineum are characteristic. Partial alopecia is typical. Itching is common. Women at puberty or after are typically affected with men developing lesions only one-tenth as often. Four cases of FFD subsequent to laser hair removal have been described [Cosmet Laser Ther 2014; 16:141–3].
Topical and IL corticosteroids may be tried. Birth control pills may be helpful as may tretinoin. An oral retinoid gave temporary relief in one case. Topical tacrolimus helped one of two woman with axillary FFD [Case Reports in Dermatological Medicine;2015]. Mechanical destruction of the apocrine glands via liposuction-assisted curettage, electrocautery, or surgical excision have all had some success.
Botox injection at the site of axillary involvement remitted pruritus completely in 15 days with sustained benefit over 8 months in one patient [BJD 2016;174;458].
Dermatology Online Journal 18(12)
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