Fordyce Spots Look Like Milia, but Are Very Different

If you're the type to examine every pore in the mirror, you may have noticed tiny white or pale yellow bumps along the ridges of your lips, inner cheeks, or nipples. These spots—which aren't always raised, but can be—are actually called Fordyce spots, and they're enlarged sebaceous glands. Totally harmless, Fordyce spots occur in about 70% to 80% of the population, and we're typically born with them. Any concern tends to be cosmetic, as Fordyce spots don't lead to any other condition or illness and aren't cause for concern.

Ahead, three dermatologists explain what you need to know about Fordyce spots, and the treatment options available should you choose to get rid of them for aesthetic reasons.

What Are Fordyce Spots?

Fordyce spots are normal, and most people are born with them, explains Dr. Michele Green, a cosmetic dermatologist in New York City. These white or pale yellow spots may be, she says, flat or slightly raised. Green adds that "Fordyce spots typically appear on mucosal surfaces of the face and body," including the lips, inner cheeks, and nipples, and are also sometimes present on the genitals—all parts of the anatomy that have oil and sweat glands. They affect people assigned female or male at birth. Dr. Azza Halim, an MD, in Boca Raton, FL, notes that people assigned male at birth tend to have more spots than people assigned female at birth, but adds that the spots are often aggravated by hormonal fluctuations.

Green adds, "We are born with them, but they may appear more during times of hormonal change, such as during puberty or pregnancy [for people assigned female at birth]. They may also appear more visible in people who tend to have oily skin." Dr. Nina Desai, a board-certified dermatologist in Manhattan Beach, CA, adds that they also tend to appear larger on stretched skin.

Halim notes that Fordyce spots range in size from 1 mm to 5 mm, on average. She says they're "rarely noticeable and can be isolated or in clusters." Desai adds that they commonly occur in "crops of about 50 to 100."

Despite being benign, Fordyce spots can be bothersome from what Green calls "an aesthetic standpoint." Desai adds that "sometimes Fordyce spots cause worry to an individual, especially when they are noticed in the genital region. However, they are completely harmless no matter the location. They are not a sexually transmitted disease and they are not infectious."

Causes and Prevention

Since we all have oil and sweat glands, most people have Fordyce spots. There are no known causes—typically, these appear at birth. As such, there's no real prevention. Halim says that sometimes an associated condition, Fox-Fordyce (explained below), might be triggered by heat, humidity, and friction of the skin.

Additionally, since these spots appear more visible in people with oily skin, controlling oil production may make them less noticeable. It's important never to pop a Fordyce spot that appears raised. "I urge my patients not to pick or squeeze at the spots," explains Desai. "This will only cause them to become inflamed and will not get rid of them."

Associated Conditions

Because Fordyce spots may be mistaken for other skin conditions, it's always advisable to seek diagnosis from a board-certified dermatologist. Additionally, they can sometimes be related to a condition called Fox-Fordyce, which is when the sweat glands become enlarged producing minor skin eruptions. Halim notes that this condition more commonly affects people assigned female at birth, and can flare up with major hormonal events, like childbirth.

Sometimes Fordyce spots may be mistaken for milia, which according to Halim are "blocked pores that present as tiny white bumps under the skin. Epidermoid cysts that are hard small bumps under the skin may also look similar," she says. Green adds that Fordyce spots may sometimes be confused with cysts or warts. Finally, they may look similar to basal cell skin cancer, underscoring the importance of a proper medical assessment and, adds Halim, an "annual skin check."

There are a couple conditions associated with Fordyce spots, though the literature is not absolute. According to a study published by the National Institutes for Health (NIH), Fordyce spots inside the mouth may be linked to elevated cholesterol. In reference to this study, Halim points out that "if cholesterol is elevated, then one may develop various skin conditions such as Fordyce spots, as well as xanthelasma, fatty deposits from excess cholesterol that are also whitish yellow in tone." She is careful to note that there's no causal relationship here.

Halim adds that "other literature has cited the link between Fordyce spots in the mouth with inherited colorectal cancer. To clarify, the individuals had a genetic form of colorectal cancer which then also had these spots. Many correlations can be made, as well as considering closer screenings for colorectal cancer in patients that present with oral Fordyce spots and may be unaware of any family history. Additional research is needed to confirm a cause-effect link to such disease entities."

Our experts agree that, as with any skin condition, it's crucial to seek proper diagnosis from a board-certified dermatologist to rule out serious medical issues.

Diagnosis and Treatment Options

In order to get an effective diagnosis, you may have to undergo a skin biopsy. Halim notes that this is in cases where there might be confusion; most times, a dermatologist will be able to make a visual assessment. Once you're diagnosed with Fordyce spots, which are benign and harmless according to our experts, you may seek to treat them for aesthetic purposes. "Treatment is rarely needed unless they are visible or bothersome to the patient," she says. "Since they are not a disease and are just enlarged oil glands, they may resolve on their own without treatment."

Green advises against self-treatment for a couple of reasons. "Due to the sensitivity of the areas where the spots appear, it is advised not to apply over-the-counter spot removal products. Most of the over-the-counter spot removals contain retinols or chemical exfoliators, which often do more harm than good in those super-sensitive areas." Additionally, these might not even be effective in treating the appearance of Fordyce spots. "If interested in treating the appearance of the spots, please ask your dermatologist about the correct methods they offer for reducing their appearance," she says.

Treatment options include lasers, cryotherapy, peels, topical creams, electrocautery, as well as surgical excision. "The treatments depend on the color, texture, and nature of the spots," says Green. "If the spots are smaller and more granular, your dermatologist may recommend electrocautery, also known as electrodessication." She describes this procedure as a "a small zapping” from a pinpoint needle used to burn a very localized portion of skin. "The procedure is usually done within a minute. Patients should expect small scabbing and crusting in the area until it is fully healed after a few days."

If the spots are more flat, Green suggests a chemical peel or exfoliant such as TCA peel. "A TCA peel is a chemical exfoliator that comes in various strength and combinations of salicylic acid," says Green. "Patients should expect mild burning, redness, and flaking or peeling for a few days. Sunscreen is absolutely necessary after any peel as to avoid any unnecessary burning. The number of treatments required vary from person to person."

In some rare cases, the spots may be red and clustered, and your dermatologist may recommend a laser. Green uses VBeam lasers, which she says feel like "a rubber band snapping" during treatment." She says the treatment itself is very quick. "Patients should expect to feel mild burning and swelling, but redness is also common," Green says, "It is important to apply sunscreen regularly during this time and avoid sun exposure. A few sessions may be required. In some circumstances, a stronger laser such as Fraxel or a CO2 laser may be recommended to eradicate the appearance."