Departments of 1Dermatology & Venereology and 2Pathology, Virgen de las Nieves Hospital, Granada, Spain
*Corresponding Author e-mail: gonzaloblascomorente@gmail.com 

مرض فوكس فورديس
 جونزالو بال�شكو-مورينتى، م�ري� خو�شيه ن�رانخو-دي�ز، اإ�رضائيل برييز-لوبيز، اأنطونيو م�رتينيز-لوبيز، ريك�ردو رويز-فيالفريد،

خو�شي اأنريو�ص-فرن�نديز

Fox-Fordyce Disease
*Gonzalo Blasco-Morente,1 María J. Naranjo-Díaz,1 Israel Pérez-López,1 Antonio Martínez-López,1 

Ricardo Ruiz-Villaverde,1 José Aneiros-Fernández2

A 42-year-old woman presented to the Department of Dermatology & Venereology, Virgen de las Nieves Hospital, Granada, Spain, 
in May 2015 with a severe pruritic rash and hair loss 

in both axillary regions. Physical examination showed 
skin coloured papules and alopecia [Figure 1A], 
which showed no fluorescence under a Wood’s lamp. 
Dermoscopy revealed hair follicle-centred papules, 

Figure 1A–D: A 42-year-old woman with Fox-Fordyce disease with (A) skin coloured papules of 1–2 mm and moderate 
alopecia in the right axilla and (B) folliculocentric papules with a few traumatised terminal hairs and blackheads. 
Haematoxylin and eosin stains showed (C) inflammatory infiltrate of lymphocytes affecting the follicle at x10 magnification 
and (D) eccrine and apocrine sweat glands showing dilatation at x4 magnification. 

interesting medical image 

Sultan Qaboos University Med J, February 2016, Vol. 16, Iss. 1, pp. e119–120, Epub. 2 Feb 16
Submitted 14 Jul 15
Revision Req. 7 Sep 15; Revision Recd. 30 Sep 15
Accepted 25 Oct 15 doi: 10.18295/squmj.2016.16.01.025



Fox-Fordyce Disease

e120 | SQU Medical Journal, February 2016, Volume 16, Issue 1

features include dilatation of the follicular infundibula 
with hyperkeratosis, acanthosis and spongiosis of the 
infundibular epithelium and perifollicular infiltration 
of lymphocytes and foamy histiocytes, leading to hair 
loss.3–5 Differential diagnoses which can be considered 
include Graham-Little-Piccardi-Lasseur syndrome 
and trichostasis spinulosa; however, patients with FF 
disease would not have cicatricial alopecia or lesions 
elsewhere on the body or the mucosa.5

Various treatments for FF disease have been 
suggested with limited improvement, including 
the administration of oral contraceptives; topical, 
intralesional or systemic corticosteroids; topical  
clindamycin; pimecrolimus; phototherapy; surgical 
treatments like electrocoagulation and curettage 
with liposuction; and topical and oral retinoids, as 
prescribed in the current case.1–5

References
1. Kassuga LE, Medrado MM, Chevrand NS, Salles Sde A, Vilar 

EG. Fox-Fordyce disease: Response to adapalene 0.1%. An 
Bras Dermatol 2012; 87:329–31. doi: 10.1590/S0365-059620 
12000200029.

2. Kao PH, Hsu CK, Lee JY. Clinicopathological study of Fox-
Fordyce disease. J Dermatol 2009; 36:485–90. doi: 10.1111/ 
j.1346-8138.2009.00689.x.

3. Yost J, Robinson M, Meehan SA. Fox-Fordyce disease. Dermatol 
Online J 2012; 18:28.

4. Milcic D, Nikolic M. Clinical effects of topical pimecrolimus in 
a patient with Fox-Fordyce disease. Australas J Dermatol 2012; 
53:e34–5. doi: 10.1111/j.1440-0960.2010.00711.x.

5. George A, Bhatia A, Thomas E. Fox-Fordyce disease: A report 
of 2 cases responding to topical clindamycin. Indian J Dermatol 
Venereol Leprol 2015; 81:87–8. doi: 10.4103/0378-6323.148597.

traumatised terminal hairs and blackheads [Figure 1B]. 
The histology of the skin biopsy indicated an 
inflammatory infiltrate of lymphocytes affecting the 
follicle [Figure 1C] and the obstruction of the eccrine 
and apocrine sweat glands [Figure 1D]. The patient was 
diagnosed with Fox-Fordyce (FF) disease. Following 
treatment with tretinoin (0.05%), she demonstrated 
moderate symptomatic improvement. 

Comment

FF disease is a rare and chronic condition usually 
seen in adolescent women which affects the apocrine 
gland-bearing areas. The underlying aetiology of 
FF remains unclear, although a history of trauma 
caused by laser hair removal or hormonal factors 
may be triggers.1–4 The pathophysiology consists of 
the obstruction of the apocrine gland duct due to the 
insertion of a keratin plug in the hair follicle wall. This 
causes secretion retention with consequent rupture of 
the glandular structure and secondary inflammation 
of the dermis.2,3 The extravasation of the glandular 
content can be the cause of the pruritus.3 Clinically, 
the lesions are uniform, firm, folliculocentric papules, 
which can range in colour from normal skin colour to 
slightly brownish.3–5 The axillae are the most common 
areas involved, as in the present case, although FF 
also can involve the anogenital and periareolar areas, 
lips, umbilicus, sternum, perineum and upper medial 
aspects of the thighs.3,4 

The diagnosis of FF disease is based on 
characteristic clinical features, as well as non-specific 
histopathological features.1–5 The histopathological 

http://dx.doi.org/10.1590/S0365-05962012000200029
http://dx.doi.org/10.1590/S0365-05962012000200029
http://dx.doi.org/10.1111/j.1346-8138.2009.00689.x
http://dx.doi.org/10.1111/j.1346-8138.2009.00689.x
http://dx.doi.org/10.1111/j.1440-0960.2010.00711.x
http://dx.doi.org/10.4103/0378-6323.148597