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lupus miliaris disseminatus faciei; facial idiopathic granulomas with regressive evolution (LMDF, FIGURE)
Etiology:
- idiopathic
Epidemiology:
- rare, but may be more prevalent in Japan
- young adults most commonly affected, but may occur at any age
Pathology:
- chronic, inflammatory dermatosis
- may be variant of granulomatous rosacea
- may be granulomatous reaction to hair follicle destruction or ruptured epidermal cysts
- early lesions:
- superficial perivascular & periappendiceal lymphocytic infiltrates
- a few histiocytes & neutrophils
- mature lesions
- round granulomas, often with caseation necrosis mimicking miliary tuberculosis
- mixture of sarcoidal & tuberculoid granulomas also may be seen
- late lesions
- fibrosis with scattered lymphocytes, histiocytes, & neutrophils
- may be perifollicular
- may show epidermal thinning
* histopathology images [1,2]
Clinical manifestations:
- red-to-yellow or yellow-brown papules of the central face, especially on & around the eyelids
- solitary lesions or in crops
- lesions occasionally generalized
- spontaneous resolution in 1-3 years common
- residual scarring may be disfiguring
- recurrence uncommon
* images [1,3,4]
Laboratory:
- none indicated unless sacroidosis suspected
Special laboratory:
- skin biopsy if diagnosis is in doubt
Radiology:
- not indidated unless sacroidosis suspected
Differential diagnosis:
- acne vulgaris
- complications of sarcoidosis
- Hydroa vacciniforme
- leprosy
- rosacea
- syringoma
- trichoepithelioma
Management:
- pharmaceuticals
- dapsone (oral)
- oral dapsone + topical tacrolimus for refractory disease [4]
- dapsone in combination with prednisolone [4]
- other pharmaceutical treatments may be less effective [4]
- intralesional triamcinolone
- tetracycline
- antimalarials
- pyridoxine, riboflavin
- isotretinoin
- surgery
- scar revision procedures (laser resurfacing, dermabrasion, chemical peel) may be useful for residal scarring
- Laser therapy [3]
General
rosacea
cutaneous lupus erythematosus
miliaria (heat rash, sweat rash)
References
- Elston DM, James WD
Medscape: Lupus Miliaris Disseminatus Faciei.
https://emedicine.medscape.com/article/1070740-overview
- Lupus miliaris disseminatus faciei pathology
DermNet NZ
https://www.dermnetnz.org/topics/lupus-miliaris-disseminatus-faciei-pathology
- Jih MH, Friedman PM, Kimyai-Asadi A et al
Lupus Miliaris Disseminatus FacieiTreatment With the 1450-nm
Diode Laser.
Arch Dermatol. 2005;141(2):143-145
PMID: 15724009
https://jamanetwork.com/journals/jamadermatology/fullarticle/392277
- Gosch M, Larrondo J.
Images in Dermatology
Lupus Miliaris Disseminatus Faciei.
JAMA Dermatol. Published online January 19, 2022
PMID: 35044421
https://jamanetwork.com/journals/jamadermatology/fullarticle/2787960