Fox–Fordyce-like disease following laser hair removal appearing on all treated areas

Abstract

Fox-Fordyce disease is an uncommon inflammatory disease of the apocrine sweat glands. Two recent reports indicated laser hair removal as a novel cause of axillary Fox-Fordyce disease. We report the first case of Fox-Fordyce disease developing in women after completing treatment with a depilatory hair laser appearing in the axillae, umbilicus, and pubis. We describe a case of Fox-Fordyce disease that developed in a 27-year-old woman 3 months after she had completed two LightSheer Diode laser treatments of her axilla, periumbilical region, and bikini area. Clinical and histopathological changes are as well detailed. Laser therapy induces damage to follicular infundibulum, resulting in altered maturation of keratinocytes which led to keratin plugging causing the common pathologic features in Fox-Fordyce disease. Differences in the physiologic features of the anatomic sites, in the susceptibility to laser-induced injury among these areas, or additional factors may contribute to Fox-Fordyce disease.

Fox–Fordyce Disease: An under‐diagnosed adverse event of laser hair removal?

“…Fox–Fordyce Disease (FFD), also known as apocrine miliaria, is a rare chronic inflammatory skin disease affecting apocrine glands . It mainly affects post‐pubertal women between 13 and 35 years of age . It is rarely reported prior to puberty, after menopause or in men .…”

“…Mast cells were absent in all reported cases as well as in our patients (Table ). Xanthomatous inflammation is considered to be the final step in the pathogenesis of classic FFD when the body attempts to collect the lipid‐laden apocrine secretions in the cytoplasm of reactive histiocytes . The two reported cases were considered to be a variant of FFD since foam cells were absent.…”

“…Fox–Fordyce Disease (FFD) is a rare chronic inflammatory skin disease of the apocrine glands, mainly affecting post‐pubertal women . It involves apocrine gland‐bearing areas including the axilla, areola, anogenital area and umbilicus . It is characterized by multiple, skin‐coloured to yellowish, perifollicular, usually pruritic, uniform papular skin lesions with associated hypotrichosis and hyperkeratosis .…”

“…There are a lot of controversies concerning its pathogenesis which remains unknown. Fox–Fordyce disease has been reported to occur after completing a series of axillary hair removal . The pathogenesis of laser hair removal‐induced FFD is still unknown.…”

“…1 It involves apocrine gland-bearing areas including the axilla, areola, anogenital area and umbilicus. [1][2][3][4][5] It is characterized by multiple, skin-coloured to yellowish, perifollicular, usually pruritic, uniform papular skin lesions with associated hypotrichosis and hyperkeratosis. [2][3][4][5] There are a lot of controversies concerning its pathogenesis which remains unknown.…”