Introduction: Fordyce spots, named after J.A. Fordyce who first described them in 1896, are ectopic sebaceous glands often found on the buccal mucosa. These common lesions develop over time in the general population, affecting up to 90% of adults, but are rarely recognized in the neonate. Case Report: A female neonate was born average for gestational age at 38 weeks’ gestation via spontaneous vaginal delivery to a 34-year-old G1P1 mom who received appropriate prenatal care. Pregnancy and delivery were uncomplicated. Baby received vitamin K, erythromycin ointment, and hepatitis B vaccine at birth. By the second day of life, the patient had lost 9% of her birthweight and there were concerns for a poor latch affecting her ability to transfer at the breast. Her mother worked closely with lactation consultants and supplemented with human donor milk (HDM). On feeding assessment, the nurse noticed “blisters” on the baby’s inner lower lip (Fig 1) and discussed with the pediatric team her concern for an infectious etiology and potential to spread to mother’s nipples. She advised the mother to stop breast feeding immediately and return to supplementing with HDM. On exam, the patient was noted to have clustered yellow papulovesicular lesions on the lower inner lip, without evidence of inflammation, suggesting a non-infectious etiology. However, given the potential morbidity and mortality associated with undiagnosed neonatal herpes simplex virus infection, pediatric dermatology was consulted and ultimately diagnosed this patient with Fordyce spots. Discussion The crop of 1-2mm circular, yellow, clustered papules on the central lower mucosal lip, without surrounding erythema or inflammation, are most consistent with intra-oral sebaceous glands (Fordyce spots or granules)— a benign condition thought to be related to the effects of maternal androgens. The neonate also has noticeable sebaceous gland activity of the nose and cheeks, possibly as a result of the same maternal androgens. It is possible that because of the benign nature of the lesions, and the location inside of the oral mucosa, Fordyce spots are underreported or under diagnosed in the neonatal population. As Dr. Fordyce indicated in his original paper in 1896, these spots had surely been an element of the typical patient panel well before 1895, but had “hitherto escaped observation” in the general population. It is important that benign Fordyce spots are recognized and differentiated from infectious lesions of the mouth, such as herpes simplex virus, to prevent the discontinuation or delay of breastfeeding in the neonate and to prevent unnecessary interventions. Conclusion The parents were reassured of the benign nature of this condition and instructed that should the lesions spread or become symptomatic, they should be re-evaluated. Baby returned to breastfeeding and was discharged to home with plans outpatient follow up in place.

Inner Lip Lesions

Two-day-old female with poor latch presents with multiple yellow papules on lower lip.