Response to ablative carbon dioxide laser in lip epidermization

CASE REPORT

A 31-year-old male presented with asymptomatic, skin-colored patches over both lips for the past 1 year. On examination, multiple, smooth, skin-colored patches with irregular margins were seen extending from the vermilion border onto the upper lip, and a single, smooth (1.3 cm × 0.5 cm) whitish-yellow patch lighter than the surrounding skin was observed adjacent to the vermilion border on the lower lip [Figure 1a]. No similar lesions were noted elsewhere on the body. Dermoscopic examination revealed these patches to be composed of multiple, tightly packed, whitish to yellowish, pinhead-sized dots [Figure 1b]. Histopathological examination showed sebaceous glands underlying the stratified squamous epithelium of the lip. These glands were not associated with hair follicles and showed no ductal communication with the epithelial surface [Figure 2].

Close

Figure 1

(a): Smooth, skin-colored patches with irregular margins on the upper lip and a smooth, whitish-yellow patch on the lower lip; (b): Multiple, tightly packed, whitish to yellowish, pinhead-sized dots on dermoscopy (DL4, polarized mode, 10x).

Export to PPT

Close

Figure 2:

Histopathological section showing sebaceous glands (red arrows) underlying the stratified squamous epithelium of the lip not associated with hair follicles and without ductal communication with the epithelial surface. (Hematoxylin and eosin, 10x).

Export to PPT

The patches were ablated with a CO₂ laser at 2 W power in continuous wave mode. Postoperatively, the patient was prescribed topical 0.05% desonide at bedtime for 3 days, followed by saline soaks and topical 2% mupirocin bid for the next 5 days. Wound healing was monitored for 3 weeks after the procedure with regular follow-up till 6 months. The normal pink appearance of the vermilion returned at 21 days post-procedure. Complete healing with no scarring, hyperpigmentation, or recurrence was observed [Figure 3a]. Dermoscopic examination of the treated areas showed an appearance indistinguishable from the surrounding lip surface [Figure 3b].

Close

Figure 3

(a): Post-treatment showing normal lip appearance without scarring or hyperpigmentation; (b): Dermoscopic image following ablative CO2 laser indistinguishable from normal skin (DL4, polarized mode, 10x).

Export to PPT

DISCUSSION

Epidermization of the lip has been defined as smooth leukokeratosis of the vermilion border with histopathology showing hyperkeratosis without parakeratosis or cellular atypia.^[4] Recent studies have suggested that lip epidermization results from the presence of multiple, coalescing, white to yellow Fordyce’s spots on the lip corresponding to ectopically located sebaceous glands without hair follicles.^[1,2] Our findings confirm the presence of closely packed Fordyce’s spots comprising the lesions of lip epidermization. In contrast, the histopathology of normal vermilion of the lip is characteristically devoid of sebaceous glands and hair follicles.

The etiopathogenesis of Fordyce’s spots is unknown. An increased incidence has been observed with increasing age, suggesting a hormonal influence.^[5] Previous studies show the prevalence of Fordyce’s spots in early or middle-aged adults and the elderly.^[3,5] A mean incubation period of 1.9 years is reported in the literature.^[3] Our patient was a 31-year-old male with a 1-year history of lesions.

Fordyce’s spots are asymptomatic and usually seen on the lips, buccal mucosa, and genital mucosa.^[3] On histopathological examination, Fordyce’s spots are composed of dermal or submucosal sebaceous glands opening directly onto the epithelial surface without an associated hair follicle.^[3] A recent study reported the sebaceous glands in Fordyce’s spots to be lacking both hair follicles and direct ductal opening onto the surface.^[1] In this patient, sebaceous glands were observed without associated hair follicles or ductal communication with the surface.

The treatment is usually not required as Fordyce’s spots are asymptomatic. However, they do not resolve spontaneously and may be a cosmetic concern for some patients.^[3] A retrospective case series of 16 patients with Fordyce’s spots treated two patients with CO₂ laser, one patient underwent electrodessication, and 5 underwent lesion excision.^[3] No recurrence was reported among treated patients, but the duration of post-procedure follow-up was not specified, and clinical or dermoscopic appearance of lips after treatment was not described. Another study reported the use of CO₂ laser for the treatment of Fordyce’s spots, but treatment outcomes were not reported.^[1]

CONCLUSION

In this patient, complete healing of treated lesions was observed in 21 days after CO₂ laser, with restoration of normal lip appearance without scarring or hyperpigmentation and no recurrence in 6 months of follow-up. Dermoscopy showed treated areas to be indistinguishable from the surrounding lip surface, thus demonstrating ablative CO₂ laser as an effective treatment modality.