Fox-Fordyce disease
Overview
Fox-Fordyce disease is a rare skin disorder that occurs mainly in women between the ages of 13 and 35 years. However, it sometimes affects males and children. The condition is also referred to as ‘apocrine duct occlusion’ and ‘sweat retention disease’. The condition is characterised by the development of itchy bumps around the hair follicles of the underarm area, pubic region, and/or around the nipples. It results from inflammation of the aprocrine sweat glands, which are found only in these areas.
Symptoms
Fox-Fordyce disease may result in very intense itch that disturbs sleep, but in some cases does not result in any symptoms. The condition frequently occurs under conditions of heat, humidity, friction and stress. Common features include: Dome-shaped flesh-coloured to reddish small papules affecting almost every hair follicle in the area Darkened, thickened and dry skin as a consequence of scratching (lichenification) Reduced or absent sweating in the affected area. The condition may persist for many years. In some instances it may clear up in pregnancy for unknown reasons. In others it may resolve at the menopause (but it may also persist afterwards).
Causes
The cause of Fox-Fordyce disease is unknown. For some reason apocrine sweat becomes trapped as a scaly plug forms in the hair follicle. The apocrine sweat ducts rupture, leak and become inflamed, resulting in intense itching. Factors identified as playing a part in the development of the condition include: Emotional and/or hormonal influences Alterations in sweat components
Diagnosis
Diagnosis is made on patient history and clinical appearance of the rash
Treatment
There is no cure for Fox-Fordyce disease. Medical treatments that have been used with varying degrees of success include: Topical retinoids Topical steroids Oral antibiotics Clindamycin solution Antiandrogenic hormonal therapy Other forms of treatment used are ultraviolet radiation (phototherapy), dermabrasion, liposuction and surgical excision.