Extrafacial nuchal lupus miliaris disseminatus faciei

Pruitt, Laura; Fowler, Carley O.; Page, Robert N.; Coleman, Neil M.; King, Roy

doi:10.1016/j.jdcr.2017.04.009

Cited by 6 publications

(5 citation statements)

References 16 publications

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“…Cases of extrafacial involvement of LMDF have rarely been reported. [4][5][6] Several inflammatory cytokines, such as tumor necrosis factor (TNF) and IL-1 are important in granuloma formation, which may suggest that a T-helper (Th)1-driven pathway is involved in the pathogenesis of LMDF. SjS and SLE are Th1-dominated diseases, and their shared pathomechanisms may thus play a role in the induction of LMDF.…”

Section: Discussionmentioning

confidence: 99%

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Lupus miliaris disseminatum faciei in a patient with systemic lupus erythematosus and Sjögren’s syndrome

2020

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We herein report a rare case of lupus miliaris disseminatus faciei on the chin and neck in a patient with systemic lupus erythematosus and Sj€ ogren's syndrome. Histopathological features showed focal aggregates of epithelioid granulomas accompanied by mononuclear cell infiltration in the upper dermis. Immunohistological examination showed enhanced expression of CD68 and CD163. Recent findings have implicated a key role of innate immunity in the pathogenesis of systemic lupus erythematosus, and alteration in M1 and M2 macrophage profile has been suggested. Increased expression of CD163 in the affected skin and other organs, and elevated serum levels of soluble CD163, are reported in systemic lupus erythematosus. Our results may suggest that activated M2 macrophages participated in the induction of lupus miliaris disseminatus faciei in a patient with systemic lupus erythematosus and Sj€ ogren's syndrome.

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Section: Discussionmentioning

confidence: 99%

“…Our case histologically showed focal aggregates of epithelioid granulomas accompanied by mononuclear cell infiltration in the upper dermis, but central necrosis was not observed. Cases of extrafacial involvement of LMDF have rarely been reported 4–6 …”

Section: Discussionmentioning

confidence: 99%

Lupus miliaris disseminatum faciei in a patient with systemic lupus erythematosus and Sjögren’s syndrome

2020

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“…A definite treatment plan for LMDF is currently unavailable. [ 4 ] Here, we report the case of a patient with LMDF cured by treatment with ornidazole, which fights against Demodex, suggesting Demodex mites may be the cause of LMDF.…”

Section: Introductionmentioning

confidence: 99%

Demodex-induced Lupus miliaris disseminatus faciei

Luo¹,

Wu²,

Zhang³

et al. 2020

Medicine

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Rationale: Lupus miliaris disseminatus faciei (LMDF) is an inflammatory granulomatous skin disease without a clear etiology that frequently involves the middle area of the face and the upper eyelids. Pathological features of the disease include caseation necrosis and epithelioid granuloma. Consensus treatment for LMDF is currently unavailable. Patient concerns: A 47-year-old Chinese female patient who presented with facial pruritic, erythematous papules 8 months before this study. She was diagnosed with skin tuberculosis at another hospital and given antituberculosis medication. However, the treatment was not efficacious. Diagnoses: In this study, the diagnosis of Demodex-induced LMDF was made by a dermatologist according to physical examination, skin biopsy pathology, and microscopic examination. Interventions: The patient was given ornidazole tablets (500 mg twice a day) and recombinant bovine basic fibroblast growth factor gel (0.2 g/cm 2 twice a day) for an 8-week period. Outcomes: Eight weeks after the treatment, the facial erythematous papules were improved, and no new skin lesions were observed. The patient showed no signs of recurrence during the 6-month follow-up. Lessons subsections: This case showed that ornidazole combined with recombinant bovine basic fibroblast growth factor gel might be useful in treatment of Demodex-induced LMDF. In addition, the results suggested that pathological caseation necrosis was caused by a series of inflammatory and immune responses to Demodex infection.

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“…axillae, and torso) have been described. 3 Histopathologically, LMDF is characterized by a granulomatous infiltrate, which is sometimes centered around the pilosebaceous unit. Sarcoid (noncaseating) and tuberculoid (with central caseation necrosis) granulomas have been observed.…”

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confidence: 99%

“…It commonly manifests as solitary or multiple 1- to 3-mm skin-colored to yellow-brown papules that involve the eyelids and central and lateral aspects of the face. Infrequently, extrafacial lesions (neck, axillae, and torso) have been described . Histopathologically, LMDF is characterized by a granulomatous infiltrate, which is sometimes centered around the pilosebaceous unit.…”

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confidence: 99%

Lupus Miliaris Disseminatus Faciei

Gosch

Larrondo

2022

JAMA Dermatol

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A woman in her 40s presented with a year history of an asymptomatic, expanding papular eruption on the face. She denied any systemic symptoms. Physical examination revealed multiple small, symmetrical, reddish brown papules on her cheeks, nose, and eyelids (Figure). Skin biopsy results showed multiple perifollicular epithelioid cell granulomas, with central areas of necrosis. Staining for fungi and acid-fast bacilli yielded negative results. A computed tomography scan of the chest, complete blood cell count, and metabolic panel were normal. A diagnosis of Lupus miliaris disseminatus faciei (LMDF) was made. The patient was refractory to treatment with systemic corticosteroids, doxycycline, and oral isotretinoin. Eight months of treatment with oral dapsone (100 mg/day) produced substantial clinical improvement that was maintained at 6-month and 1-year follow-up visits.Lupus miliaris disseminatus faciei is an uncommon granulomatous eruption of unknown origin. Current incidence rates are not well reported. It is more commonly seen in young adults, although an apparent sex predilection has not been established. 1 Pathogenesis is still uncertain. At first, LMDF was thought to be a tuberculid because of its clinicopathological findings. However, many studies have failed to demonstrate the presence of Mycobacterium tuberculosis within LMDF granulomas. Also, there is no response to antitubercular drugs, and the tuberculin test often yields negative results. Demodex folliculorum presence was once considered to play a role in forming caseating granulomas, but D folliculorum has not been consistently observed in LMDF lesions. Lupus miliaris disseminatus faciei has also been considered a variant of granulomatous rosacea; however, both diseases have different clinical features and courses, considering that LMDF a self-limiting condition. An altered pilosebaceous unit antigenicity with a foreign body granulomatous response seems possible in LMDF. 2 Because of its clinical findings, LMDF can mimic other medical conditions with underlying systemic involvement, including sarcoidosis, cutaneous tuberculosis, and deep fungal infections. It commonly manifests as solitary or multiple 1-to 3-mm skin-colored to yellow-brown papules that involve the eyelids and central and lateral aspects of the face. Infrequently, extrafacial lesions (neck,

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Extrafacial nuchal lupus miliaris disseminatus faciei

Cited by 6 publications

References 16 publications

Lupus miliaris disseminatum faciei in a patient with systemic lupus erythematosus and Sjögren’s syndrome

Lupus miliaris disseminatum faciei in a patient with systemic lupus erythematosus and Sjögren’s syndrome

Demodex-induced Lupus miliaris disseminatus faciei

Lupus Miliaris Disseminatus Faciei

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