lupus miliaris disseminatus faciei; facial idiopathic granulomas with regressive evolution (LMDF, FIGURE)
Jump to navigation
Jump to search
Etiology
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
Laboratory
- none indicated unless sacroidosis suspected
Diagnostic procedures
- 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]
More general terms
References
- ↑ 1.0 1.1 1.2 Elston DM, James WD Medscape: Lupus Miliaris Disseminatus Faciei. https://emedicine.medscape.com/article/1070740-overview
- ↑ 2.0 2.1 Lupus miliaris disseminatus faciei pathology DermNet NZ https://www.dermnetnz.org/topics/lupus-miliaris-disseminatus-faciei-pathology
- ↑ 3.0 3.1 3.2 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: https://www.ncbi.nlm.nih.gov/pubmed/15724009 https://jamanetwork.com/journals/jamadermatology/fullarticle/392277
- ↑ 4.0 4.1 4.2 4.3 4.4 Gosch M, Larrondo J. Images in Dermatology Lupus Miliaris Disseminatus Faciei. JAMA Dermatol. Published online January 19, 2022 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35044421 https://jamanetwork.com/journals/jamadermatology/fullarticle/2787960