Lupus Miliaris Disseminatus Faciei Part II: An Overview

Abstract

Lupus miliaris disseminatus faciei, a chronic inflammatory disorder, is a controversial and enigmatic diagnostic/therapeutic entity. Multiple, discrete, smooth 1–3 mm brown/red or brown‐to‐yellowish dome‐shaped papules (sometimes with mild scaling) are its clinical characteristics. The lesions are usually located on the central and lateral side of the face. The condition is most often seen in young adults of both sexes, and diascopy may reveal apple‐jelly nodules. Lupus miliaris disseminatus faciei has clearly been defined into four histopathologic groups: epithelioid cell granuloma with central necrosis; epithelioid cell granuloma without central necrosis (sarcoid/foreign body reaction); epithelioid cell granuloma with abscesses; and nongranulomatous, nonspecific inflammatory infiltrate. While in early lesions granuloma is absent and lymphocytes and a few neutrophils surround the follicles, fully developed lesions show well formed granuloma surrounding ruptured hair follicles, often with large numbers of neutrophils. Lupus miliaris disseminatus faciei must be differentiated from other conditions; to facilitate this, in Part I of this paper the histopathologic undertones were delineated into early, intermediate (first stage, second stage, and third stage), and late stages. This part of the article presents an overview of lupus miliaris disseminatus faciei.

Sarcoidosis Can Present with Necrotizing Granulomas Histologically: Two Cases of Ulcerated Sarcoidosis and Review of the Literature

“…11,30 Other, noninfectious causes to consider include foreign body reactions, halogenodermas, lupus miliaris disseminatus faciei, necrobiosis lipoidica, superficial ulcerative rheumatoid necrobiosis, necrobiotic xanthogranuloma, annular elastolytic giant cell granuloma, metastatic Crohn disease, squamous cell carcinoma, lymphoproliferative disorders, and immunodeficiency disorders. 2,11,15,30,[41][42][43][44][45] The goals of treatment in cutaneous sarcoidosis are symptomatic relief, improvement of disease activity, and prevention of chronic disability. 37 Corticosteroids are the mainstay of treatment in ulcerative sarcoidosis, and methotrexate is a well-tolerated, steroid-sparing alternative.…”

Dermoscopic spectrum of rosacea

“…The latter entity is characterised by disseminated reddish-yellow papules usually on the central face, especially the periorbital and perioral area. 12 These manifestations significantly overlap with the ones of granulomatous rosacea, rendering the differential diagnosis particularly challenging. In fact, it remains controversial whether LMDF is a separate entity with 'rosacea-like' features or represents an 'extreme' type of granulomatous rosacea.…”

Recalcitrant lupus miliaris disseminatus faciei improved by cyclosporine monotherapy

“…Lupus miliaris disseminatus faciei (LMDF) is a chronic cutaneous granulomatous disease characterized by multiple smooth reddish or yellowish papules on the central face, especially the lower eyelids and perioral area. [1][2][3] Owing to its clinical manifestations, LMDF has been considered as a variant of granulomatous rosacea (GA). 1,2 However, LMDF may be a distinct entity, different from GA, sarcoidosis, and cutaneous tuberculosis.…”

“…[1][2][3] Owing to its clinical manifestations, LMDF has been considered as a variant of granulomatous rosacea (GA). 1,2 However, LMDF may be a distinct entity, different from GA, sarcoidosis, and cutaneous tuberculosis. 1,2 Treatment of LMDF is usually challenging.…”

“…1,2 However, LMDF may be a distinct entity, different from GA, sarcoidosis, and cutaneous tuberculosis. 1,2 Treatment of LMDF is usually challenging. 1,3 Tetracycline, isotretinoin, hydroxychloroquine, dapsone, systemic steroids, pulsed dye laser, topical steroids, and topical calcineurin inhibitors are frequently used to treat LMDF; however, their therapeutic efficacy remains controversial.…”