Cause of painless white bumps across the top lip margin or vermillion border

A patient asked: There’s painless white bumps across my vermilion border. I counted about 12. They’ve been growing and gave been there for more than 3 weeks. Help?

The most likely cause of painless white bumps across the top lip margin or vermillion border are:
1. Virus herpes
2. Clogged skin gland or early zit
3. Dermatitis from allergy
4. Eczema
5. Fordyce Spots: good site to see images of what it looks like:
6. Kertin filled pseudocysts of clogged ducts of sebaceous glands

Sandra Lora Cremers, MD, FACS


Keratin-filled pseudocysts of ducts of sebaceous glands in the vermilion border of the lip.


Pathologic changes of free sebaceous glands are rare compared to those of the skin. Two keratin-filled pseudocysts which developed in the excretory ducts of sebaceous glands in the vermilion border of the lower lip in an 86-year-old woman are described. The entity is probably related to milia of the skin.

Fordyce Spots: Symptoms, Diagnosis and Treatments

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MNT Knowledge Center
Fordyce spots, also known as Fordyce’s spots, Fordyce granules or Sebaceous Prominence, are small raised, pale red, yellow-white or skin-colored bumps or spots that appear on the shaft of the penis, the labia, scrotum, or the vermilion border of the lips of a person’s face. They can also be found on the foreskin of the penis (called Tyson’s glands).
The vermilion (vermillion) border of the lips is the normally sharp demarcation between the red colored part of the lip and the adjacent normal skin of the face.
Fordyce spots are named after the American dermatologist John Addison Fordyce (1858-1925) who first described them clinically in a medical journal. He also coined the terms Fox Fordyce disease, Fordyce’s disease, Fordyce’s lesion, and Brooke-Fordyce trichoepithelioma.
Fordyce spots are common in both males and females.

Fordyce spots are a type of ectopic sebaceous gland:

  • Ectopic = in an abnormal location or position
  • Sebaceous – fatty, greasy, adipose, fat – relating to oil and fat
  • Glands = organs or collection of cells that secrete things. Endocrine glands secrete things, such as hormones, into the body. Exocrine glands secrete things outside the body, such as sweat or mucus
  • Sebaceous gland = a small skin gland that secretes sebum (oily matter) into the hair follicles to lubricate the hair and skin
  • Ectopic sebaceous gland = a sebaceous gland that is on the skin but not in the hair follicle.
Although Fordyce spots are sebaceous glands which are in “the wrong place” (not in hair follicles), they are not associated with any disease or illness. Dermatologists say they are of cosmetic concern only – people who have them might not be happy with how they affect the way they look.
Experts say that Fordyce spots are natural occurrences on the body and are not infectious. Some men may wonder whether they have some kind of STI (sexually transmitted infection) or cancer and see their doctor, only to be told that they are harmless.

Symptoms of Fordyce spots

Fordyce spots on face
A 30-year-old male patient, worried about herpes simplex, saw his doctor. Physical examination revealed several 1mm-wide smooth, white spots. He was diagnosed with Fordyce spots (Hong Kong Medical Association)
Small, pale (skin color, yellowish or pinkish) bumps or spots from 1 to 3 mm in diameter are visible on the:
  • Shaft of the penis (in males)
  • Scrotum (in males)
  • Where the lips on the face meet the skin of the face (vermilion border)
  • Labia (in females).
On the penis glans/shaft, scrotum and labia they may appear as bright red or purple papules, as a solitary lesion or in crops of 50 to 100. They are painless and do not itch. They are simply abnormally dilated blood vessels that are covered by thickened skin. In some cases they made bleed during/after intercourse.
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