Fordyce Bumps on the Mouth: Treatment Approach
Fordyce bumps (ectopic sebaceous glands) are benign lesions that typically require no treatment unless they cause significant cosmetic concern to the patient, in which case CO2 laser ablation offers the most effective and well-documented results.
Understanding Fordyce Bumps
Fordyce bumps are ectopic sebaceous glands that appear as tiny (1-3 mm), asymptomatic, yellowish or whitish papules on the lips' vermilion border or oral mucosa 1, 2. These are not the same as oral ulcers, angular cheilitis, or other inflammatory oral conditions described in guidelines for Behçet disease or pemphigus 3.
Treatment Decision Algorithm
Step 1: Assess Need for Treatment
- Fordyce bumps are benign and asymptomatic 1, 2
- Treatment is indicated only for cosmetic concerns 4, 5
- If the patient has no cosmetic concerns, reassurance and observation are appropriate 1
Step 2: First-Line Treatment (If Cosmetically Bothersome)
CO2 laser ablation is the gold standard treatment:
- Superpulsed CO2 laser using 2-4 W power with 2 mm spot size 5
- Typically requires 2-3 passes in one session 5
- Complete re-epithelialization occurs within 2 weeks 5
- Excellent cosmetic results with no recurrence at 4-month follow-up 4
- Minimal downtime and side effects 4
- Pinhole ablation technique specifically reduces surface damage 4
Step 3: Alternative Treatment Options
If CO2 laser is unavailable or unsuitable:
Insulated microneedle radiofrequency:
- Uses intralesional electrocoagulation with proximally insulated microneedle 2
- Achieves marked cosmetic improvement without surface damage 2
- Lower risk of scarring compared to traditional ablative methods 2
Micro-punch surgical excision:
- Effective for genital Fordyce spots (less commonly used for oral lesions) 6
- No recurrence in follow-up periods of 12-84 months 6
- More invasive approach with potential for scarring 6
Step 4: Treatments to Avoid
Isotretinoin is NOT recommended:
- Only one case report exists with dichotomous (unpredictable) long-term response 1
- Insufficient evidence for efficacy 1
- Significant systemic side effects outweigh uncertain cosmetic benefit 1
Topical corticosteroids, antifungals, and antiseptics have NO role:
- These are appropriate for inflammatory oral conditions like angular cheilitis 7, transient lingual papillitis 8, or pemphigus 3
- Fordyce bumps are not inflammatory lesions and will not respond to these agents 1, 2
Important Clinical Pitfalls
Do not confuse Fordyce bumps with:
- Angular cheilitis (requires antifungal/corticosteroid combination) 7
- Oral candidiasis (requires antifungal therapy) 3
- Yellowish plaques from invasive fungal infection in immunocompromised patients (requires systemic antifungals) 9
- Oral ulcers in Behçet disease (requires immunosuppression) 3
Key distinguishing features of Fordyce bumps:
- Asymptomatic (no pain, no inflammation) 1, 2
- Stable, non-progressive 4
- Multiple discrete papules, not ulcers or plaques 2, 4
- No systemic symptoms 1