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

BACKGROUND: 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. FFD induced by laser hair removal is a newly reported entity of unknown pathogenesis. To the best of our knowledge, there are only four reported cases in the literature describing a total of four patients.

OBJECTIVES: We are reporting the first case series of laser-induced FFD with a histopathological and clinical evaluation of the reported cases.

METHODS: A review of the available literature to date about laser-induced FFD was performed. Clinical and histopathological features were reviewed.

RESULTS: In our case series, the clinical and histological appearance of FFD following laser hair removal is similar to that of classic FFD. Exacerbating factors were present in two patients, and were similar to that of classic FFD. The main histopathological features included dilatation of the follicular infundibulum, follicular hyperkeratosis, dyskeratosis in the follicular infundibulum, periductal lymphohistiocytic infiltrate and perifollicular fibrosis. Two of the four reported cases as well as one of our patients had no perifollicular xanthomatous inflammation, a hallmark feature of classic FFD. Mast cells were absent in all reported cases, as well as in our patients.

CONCLUSION: We believe that laser-induced FFD is under-diagnosed as a newly reported adverse event of laser hair removal. It is clinically and histopathologically similar to classic FFD.