Lupus miliaris disseminatus faciei. Part I: Significance of histopathologic undertones in diagnosis

Lupus Miliaris Disseminatus Faciei of the Posterior Eyelids: A Case Report

A 70-year-old woman with a history of Demodex blepharitis presented with a 1-year history of red-yellow nodules in the tarsus of her eyelids. Excisional biopsy revealed robust caseating granulomatous inflammation, consistent with the diagnosis of lupus miliaris disseminatus faciei. Lupus miliaris disseminatus faciei is a rare granulomatous dermatosis of unknown etiology. Estimated 200 cases have been reported to date, but none have been reported affecting the posterior lamellae of the eyelids. Lupus miliaris disseminatus faciei classically presents as symmetric yellow or brown papules on the central face and eyelid skin. Infectious etiologies and systemic granulomatous disease need to be ruled out with histologic staining and serologies.

Case for diagnosis. Eyelid edema and erythematous papules disseminated on the face

Lupus miliaris disseminatus faciei or acne agminata is a chronic inflammatory disorder of the skin, considered an intriguing entity due to its pathogenesis, which is still largely speculative. It has been linked to tuberculosis, sarcoidosis, rosacea, and other granulomatous diseases, but it is considered an independent entity.

A case of lupus miliaris disseminatus faciei that was successfully treated with 595 nm pulsed-dye laser combined with drugs

Lupus miliaris disseminatus faciei (LMDF) is a rare chronic inflammatory and granulomatous skin disease characterized by reddish-brown papules and nodules on the central face. Although this disease can spontaneously resolve, disfiguring scars can often remain. This disease responds poorly to general treatments. Except for systemic hormones, the efficacy of other drugs is unclear. There are few reports on the use of laser treatment for LMDF. Here, we report a case of LMDF that was successfully treated with a 595 nm pulsed-dye laser combined with glucocorticoids and isotretinoin. The treatment outcome shows less scar formation and fewer side effects when this regimen was employed.

Lupus Miliaris Disseminatus Faciei: A Case Report and Brief Literature Review

Lupus miliaris disseminatus faciei (LMDF) is a rarely seen, granulomatous disease of the face with an unknown etiology. Clinically, the disease is characterized by monomorphic, reddish-brown, dome-shaped papules symmetrically distributed on the face. Histopathologically, a perifollicular caseating granuloma is the hallmark.

A 20-year-old male patient was referred to our outpatient clinic with multiple papules distributed on his face, and he was diagnosed with LMDF based on histopathological examination. The patient was unresponsive to the oral tetracycline treatment; however, he was successfully treated with systemic dapsone and topical tacrolimus. This is a rare case of LMDF, which showed rapid improvement with dapsone therapy.

Photodynamic therapy in lupus miliaris disseminatus faciei's scars

Lupus miliaris disseminatus faciei is an uncommon granulomatous inflammatory disease, characterized by multiple, monomorphic, reddish translucent papules and nodules, mainly located on the face. Several therapeutic options have been employed with variable results, leaving residual disfiguring scars. On this topic, we report a case of significant improvement of red-atrophic scars in a 54-year-old male after three sessions of photodynamic therapy with 10% aminolevulinic acid. Owing to the high safety profile and the excellent cosmetic result, photodynamic therapy may be considered a useful tool to both prevent and treat undesirable scarring.

Morbihan disease and extrafacial lupus miliaris disseminatus faceie: a case report

Lupus miliaris disseminatus faciei (LMDF) is characterized by discrete dome-shaped papules on the bilateral face and neck. We report the first case of LMDF with a widespread distribution of extrafacial papules and concomitant bilateral eyelid edema. A unique case of a 30-year-old man presented with nonpruritic, painless, papular eruptions (3-5 mm in diameter) involving the bilateral trunk and upper extremities, along with bilateral eyelid edema. There was no facial eruption involved. The outbreak initially involved the back, and gradually spread to the chest and wrists. The histologic examination of the eyelids revealed histiocytic epitheloid cells, dermal intercellular edema, and an expanded vascular space, which led to the diagnosis of Morbihan disease. The immunohistochemical staining of the truncal eruption revealed nodular inflammatory changes involving the middle to lower dermis around the follicles, containing histiocytes, multinucleated giant cells, and small lymphocytes. This led to the diagnosis of LMDF. The truncal papular eruption ultimately improved with roxithromycin treatment, but the eyelid edema required surgical treatment.

Lupus miliaris disseminatus faciei of the eyelids: report of two cases

Lupus miliaris disseminatus faciei is a rare chronic, asymptomatic papular eruption, most commonly affecting the central face, including the eyelids. Our 2 patients presented with the typical clinical findings of small papular lesions in which histopathologic examinations disclosed granulomatous inflammation with necrosis associated with inflamed hair follicles. Except for its description as acne agminata by Duke-Elder in 1974, to the authors' knowledge, this condition has not been reported previously in the ophthalmic literature.

Acne agminata limited to the eyelids

A 45-year-old woman had a 1-year history of multiple small papules on both upper eyelids that waxed and waned in size and disappeared in the vicinity of a steroid injection site. Acne agminata (lupus miliaris disseminatus faciei, acnitis, papular tuberculid) is a rare form of necrotizing granulomatous inflammation of the dermis that has received scant attention in the ophthalmologic literature. The diagnosis is reached by excluding other forms of necrotizing granulomatous dermatitis based on clinical and histologic features.

Axillary acne agminata (lupus miliaris disseminatus faciei with axillary involvement)

Acne agminata (AA) and lupus miliaris disseminatus faciei (LMDF) have been used to describe very similar clinical conditions and it is now generally accepted that they are synonymous. The cause of these disorders has not been determined. Clinically the disease presents with often agminated redbrown to yellow papules which occasionally become pustular. Microscopically, superficial granulomatous inflammation with perifollicular caseating granulomas is the hallmark. Axillary involvement with LMDF has rarely been reported; in this area AA has been the preferred term. When only the axillae are affected, it may be difficult to distinguish acne agminata from other granulomatous diseases, especially from granulomas caused by antiperspirants containing aluminumzirconium complexes. We describe a 36-year-old woman with axillary acne agminata.