Synonym: Apocrine miliaria
disease is an uncommon, chronic eruption of apocrine
gland-bearing skin caused by blockage and intraepidermal
rupture of apocrine ducts. The resulting intensely pruritic
papules, which mainly affect the axillae and pubic regions
of postbubertal women, are difficult to treat.
occur in women between the ages of 13 and 35 years. The
disease in only 1/10th one tenth as common in
men. It has only rarely been reported before puberty
1,2 or after
menopause. Pregnancy invariably has a beneficial influence.
shortly after puberty and affects mainly the
axillary (as in quiz case) and pubic regions,
although other apocrine gland-bearing areas, such as
areolae(as in quiz case), periumblicus, and
perineum, are sometimes involved. Icthing
(as in quiz case) is often intense and may precede the
formation of typical flesh-colored follicular papules.
Paraxysmal bouts of pruritus triggered by emotional stimuli
treatment has had universal success, but the
mainstay of therapy has been oral contraceptives.
Topical treatment with 0.1% tretinoin cream.
Intralesional injection of triamcinolone acetonide
Topical clindamycin solution.
Surgical excision or dermabrasion, electrolysis and
CO2 laser intervention.
More recently effect of the pimecrolimus also been
1. Ranalletta M,
Rositto A, Drut R. Fox-Fordyce disease in two
prepubertal girls: histopathologic demonstration of
eccrine sweat gland involvement.
K, Gupta S, Kanwar AJ.
Fox fordyce disease in a prepubertal girl.
Giacobetti R, Caro WA, Roenigk HH Jr.
Fox-Fordyce disease. Control with tretinoin cream.
Dermatol. 1979 Nov;115(11):1365-6.
JR 3rd, Doyle JA. The
therapeutic uses of topical vitamin A acid.
Acad Dermatol. 1981 May;4(5):505-13. Review.
5. Miller ML, Harford RR, Yeager JK.
Fox-Fordyce disease treated with topical
Arch Dermatol. 1995 Oct;131(10):1112-3.
6. Pock L, Svrckova M,
Machackova R, Hercogova J.
Pimecrolimus is effective in
Int J Dermatol. 2006
Mehrdad Mehravaran, M.D.,
Dermatologist. / Szeged- Hungary
It is a case of Fox-Fordyce disease.
Fox-Fordyce disease is a condition of
the axillary apocrine glands and is
manifested by pruritic dome-shaped
The itching is exacerbated by increased
Most common in women, it can also occur
It is a
blockage of the
ducts with a secondary, nonbacterial
inflammatory response to the
debris in the
is very similar but tends to have a
secondary bacterial infection so
that pus-draining sinuses are
formed. It is a very devastating
disease that does not have
universally curative treatments.
The mainstay treatment is surgical
removal of the skin tissue
containing affected sweat glands.
may also be used and
are used to reduce the inflammatory
No treatment is required for Fordyce
granules, except for cosmetic
removal of labial lesions. Inflamed
glands can be treated topically with
When surgically excised, recurrence
does not occur. Neoplastic
transformation is very rare but has
Dr Reza Ghaderi
Professor of Dermatology