Chronic itching in the armpits and groin?

Let’s talk about a condition called Fox-Fordyce disease. Recall that I mentioned that there are two major types of sweat glands in the body. The apocrine and eccrine sweat glands. Remember A for Adolescence? The apocrine sweat glands do not become active until adolescence. They are usually found in areas like the armpits, groin and around the areola of the breast.

Fox fordyce disease is a chronic recurring condition of unknown cause that affects the apocrine glands with blockage of a part of the sweat gland with some shed skin (keratin). There’s occlusion of sweat and subsequent repeated inflammation. Can be associated with intense itching especially because of collection and sluggish movement of sweat with repeated inflammation. The condition is found in these areas like the armpits, groin and periareolar area where apocrine glands are numerous.

Affects females more often than males (About 9 times more common in the former). Worsened with heat and humidity in environments like ours.

Closest differential (look alike) is a condition called pseudofolliculitis barbae (shaving bumps) which usually occurs a few days after shaving. In this other condition, after shaving…ingrown hairs in the follicle tends to irritate the follicles and cause inflammation. The most important thing here is to have good shaving practices of shaving along the direction of hair growth and not against it, to ensure proper moisturising of the area post shave and to increase the interval between shaving. Stop leaving the shaving cream on for longer than the recommended time. And when the itching starts, try not to scratch vigorously as this is also a form of trauma that will irritate the follicles even more.

For Fox Fordyce, with repeated scratching, the skin may break and bacteria may then come in to cause an infection. If this occurs, it must be treated.
Management of Fox fordyce disease involves counseling, lifestyle modifications such as wearing loose cotton clothing to reduce heat and humidity. Some topical drugs such as retinoids, steroids, immunomodulators and even some antibiotics have a role.

This condition does not have any systemic effect. It’s the look and the excessive itching that may affect the quality of life of patients affected. Be sure to carry your patients along properly as it tends to run a chronic course and is manageable rather than curable. If you are suffering from Fox Fordyce disease, please read more on patient friendly sites and speak to your dermatologist.

Can you see how monomorphic the lesions look? (If I don’t add small grammar, how will you know I’m a real dermatologist? Lol). This just means all the lesions look exactly the same. Unlike in shaving bumps where you’ll have the lesions in varying sizes most times.

Featured image at the top of the post from sciencedirect.com


I decided to talk about this because I just saw a patient with Fox Fordyce recently who had seen so many people including the unofficial association of ‘dermatologists’

Any questions?