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What is the difference between PPPs and Fox Fordyce disease?

What is the difference between PPPs and Fox Fordyce disease?
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Pearly penile papules (PPPs), Fordyce spots and Fox-Fordyce disease are all distinctly different things. PPPs and Fordyce spots are natural ornaments of the penis, while Fox-Fordyce disease is an itchy sweat gland blockage. 

Confused yet? Let’s explain. 

Fox or Fordyce? 

Fordyce spots

Fordyce spots are visible oil glands that don’t contain hair follicles (which most other oil glands do) found in the mouth and genital mucosa, also known as your wet bits. Almost everyone has Fordyce spots, but they are not always visible (then they are simply an oil gland). 

Seeing an oil gland within the mucosa – now a Fordyce spot – is considered normal, and the spots are in no way a disease. American dermatologist John Fordyce named Fordyce spots after himself, as is the proud scientific custom. What is the difference between PPPs and Fox Fordyce disease?

Fordyce spots are small yellowish or white areas along the mucosa or wet-dry ridge (vermilion border) of the lips, glans or shaft of the penis, or the vulva and vagina. You might have one Fordyce spot visible or many (50-100). It’s much easier to see Fordyce spots when stretching the skin. 

While Fordyce spots are normal, they can look similar to other conditions, including sexually transmitted infections. If you’re concerned, get checked, remembering biopsy is seldom required, so no invasive tests – just your doctor’s eyes. Fordyce spots are harmless and do not require treatment. Do not pick at Fordyce spots! They are not a pimple. 

If Fordyce spots are causing a cosmetic concern, a CO2 laser or electrosurgery can remove the visible spots. 

Fox-Fordyce disease

Fox-Fordyce disease is when sweat is trapped in a hair follicle by a keratin plug. The blocked sweat duct ruptures and leaks, causing intense itching and inflammation. The itching can be severe. American dermatologist George Fox and his pal John Fordyce discovered the condition. 

Fox-Fordyce disease is not an infection of Fordyce spots; they share a name because John Fordyce was the doctor who had the honour of naming both things after himself. 

Fox-Fordyce disease mainly affects 13-35-year-old women, not men, older women, or children, and is linked with stressed or anxious emotional states, hot temperatures, hormones, sweat components and laser hair removal. 

Fox-Fordyce disease presents with small dome-shaped flesh or reddish-coloured bumps around hair follicles in the pubic area, underarms and around the nipples (the only places these special apocrine sweat glands appear on our bodies). 

With Fox-Fordyce, almost all the hair follicles in the area will be affected, not just a few, and it’ll occur on both sides of the body. Sweating may slow or stop in the area due to the blockages. Fox-Fordyce treatments include liposuction of the sweat glands or other dermatological treatments.

What is the difference between PPPs and Fox Fordyce disease?

So what are PPPs, then?

Pearly penile papules are not in any way related to Fox or Fordyce or their discoveries. Instead, PPPs are small harmless skin growths, pearly papules, that appear in a ring around the head of the penis. They’re a natural variation of skin, though we’re not sure why they exist (but there are theories!). 

PPPs are dome-shaped skin-coloured bumps located in a neat row or series of rows around the head of the penis, like a row of pearls (sort of). PPPs are not a disease and have nothing to do with either Fordyce spots or Fox-Fordyce disease. 

Between 8-43 per cent of penises will exhibit pearly papules, being more common in those not circumcised. They reduce in visibility with age. PPPs do not cause any symptoms but can cause some emotional distress due to the visible bumps on the head of the penis. Some men aren’t fond of their PPPs and opt to have them removed. 

Quick facts on PPPs

  • Normal anatomic variant
  • You did not cause these
  • Easy to diagnose by a trained eye
  • Quick and easy to remove using laser
  • Fade as you age
  • Not contagious
  • Not infectious
  • Not caused by sexual activity or masturbating
  • Not related to hygiene
  • Not malignant or pre-malignant

Comparison chart of Fordyce spots, Fox-Fordyce disease and PPPs

Fordyce spots Fox-Fordyce disease PPPs
Symptoms None Itch, inflammation None
Colour Yellowish or white Flesh or reddish Flesh
Number 1 or more 50-200+ 20-50
Location Mouth, genitals Armpits, pubic area, nipples Head of the penis
Shape Pinhead Dome Dome, star
Size 1-3mm 1-5mm 1-4mm

How to get rid of PPPs at our Melbourne clinic

While pearly penile papules do not require medical treatment, however, it can soothe a furrowed brow to have PPPs removed. Dr Michael Rich removes pearly penile papules at ENRICH Clinic in Melbourne using precise laser treatment. 

The treatment leaves the penis clear of the PPPs, with a short and usually straightforward recovery. Book a consultation with Dr Rich and walk out without your pearly papules. 

Book a consultation with Dr Rich to discuss your concerns. 

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