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Lupus Miliaris Disseminatus Faciei Medication

  • Author: Jeffrey Meffert, MD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Aug 18, 2015
 

Medication Summary

Medical treatment of lupus miliaris disseminatus faciei (LMDF) often is unsuccessful. Anecdotal reports describe improvement with a variety of therapies, including prednisone, isotretinoin, tetracyclines, and vitamins (eg, riboflavin, pyridoxine). Since LMDF spontaneously resolves within 1-2 years, the impact of therapy on the course of the disease is difficult to assess.

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Corticosteroids

Class Summary

Both topical and systemic corticosteroids have been used for their anti-inflammatory properties. In the literature, topical agents usually are described as ineffective; low-dose systemic agents reportedly work rapidly and well. Since LMDF may represent a form of rosacea, corticosteroids may provide temporary improvement, followed by chronic flaring of the disease. Caution is advised, and corticosteroids should not be administered unless other treatment options have failed.

Prednisone (Deltasone, Meticorten, Orasone)

 

Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.

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Tetracyclines

Class Summary

Tetracyclines are used for their anti-inflammatory rather than antibiotic effects. Most reports describe limited therapeutic benefit. This class includes tetracycline, doxycycline, and minocycline.

Tetracycline (Sumycin)

 

Tetracycline's anti-inflammatory mechanism of action may differ from its antibacterial mechanism of action. Some studies indicate that tetracyclines inhibit inflammatory cell migration and transformation of lymphocytes. Tetracycline treats gram-positive and gram-negative organisms and mycoplasmal, chlamydial, and rickettsial infections. It inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s).

Doxycycline (Vibra-Tabs, Vibramycin, Bio-Tab)

 

Doxycycline's anti-inflammatory effect may result from the inhibition of migration of inflammatory cells and transformation of lymphocytes. It inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Minocycline (Dynacin, Minocin)

 

Minocycline's anti-inflammatory effects may result from the inhibition of inflammatory cell migration and transformation of lymphocytes.

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Retinoids

Class Summary

Histology at various stages of the disorder suggests a follicular-based disorder, although the pathogenesis is unclear, and the predilection for eyelids is difficult to explain. How retinoids help is difficult to explain except in general terms relating to proper maturation and function of the follicular epithelium. Use of topical retinoids is not described in the literature, but presumably, they have been tried without benefit. Systemic retinoids cause severe birth defects. Adhere to current prescribing guidelines.

Isotretinoin (Accutane)

 

Isotretinoin is an oral agent that treats serious dermatologic conditions. Isotretinoin is the synthetic 13-cis isomer of the naturally occurring tretinoin (trans-retinoic acid). Both agents are structurally related to vitamin A. Isotretinoin should be prescribed only by physicians experienced and/or trained in its use.

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Contributor Information and Disclosures
Author

Jeffrey Meffert, MD Associate Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, Texas Dermatological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

David F Butler, MD is a member of the following medical societies: American Medical Association, Alpha Omega Alpha, Association of Military Dermatologists, American Academy of Dermatology, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Phi Beta Kappa

Disclosure: Nothing to disclose.

Jeffrey J Miller, MD Associate Professor of Dermatology, Pennsylvania State University College of Medicine; Staff Dermatologist, Pennsylvania State Milton S Hershey Medical Center

Jeffrey J Miller, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Society for Investigative Dermatology, Association of Professors of Dermatology, North American Hair Research Society

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References
  1. van de Scheur MR, van der Waal RI, Starink TM. Lupus miliaris disseminatus faciei: a distinctive rosacea-like syndrome and not a granulomatous form of rosacea. Dermatology. 2003. 206(2):120-3. [Medline].

  2. Skowron F, Causeret AS, Pabion C, Viallard AM, Balme B, Thomas L. F.I.GU.R.E.: facial idiopathic granulomas with regressive evolution. is 'lupus miliaris disseminatus faciei' still an acceptable diagnosis in the third millennium?. Dermatology. 2000. 201(4):287-9. [Medline].

  3. Hodak E, Trattner A, Feuerman H, et al. Lupus miliaris disseminatus faciei--the DNA of Mycobacterium tuberculosis is not detectable in active lesions by polymerase chain reaction. Br J Dermatol. 1997 Oct. 137(4):614-9. [Medline].

  4. Shitara A. Lupus miliaris disseminatus faciei. Int J Dermatol. 1984 Oct. 23(8):542-4. [Medline].

  5. Misago N, Nakafusa J, Narisawa Y. Childhood granulomatous periorificial dermatitis: lupus miliaris disseminatus faciei in children?. J Eur Acad Dermatol Venereol. 2005 Jul. 19(4):470-3. [Medline].

  6. el Darouti M, Zaher H. Lupus miliaris disseminatus faciei--pathologic study of early, fully developed, and late lesions. Int J Dermatol. 1993 Jul. 32(7):508-11. [Medline].

  7. Uesugi Y, Aiba S, Usuba M, Tagami H. Oral prednisone in the treatment of acne agminata. Br J Dermatol. 1996 Jun. 134(6):1098-100. [Medline].

  8. Tokunaga H, Okuyama R, Tagami H, Aiba S. Intramuscular triamcinolone acetonide for lupus miliaris disseminatus faciei. Acta Derm Venereol. 2007. 87(5):451-2. [Medline].

  9. Berbis P, Privat Y. Lupus miliaris disseminatus faciei: efficacy of isotretinoin. J Am Acad Dermatol. 1987 Jun. 16(6):1271-2. [Medline].

  10. Koike Y, Hatamochi A, Koyano S, Namikawa H, Hamasaki Y, Yamazaki S. Lupus miliaris disseminatus faciei successfully treated with tranilast: Report of two cases. J Dermatol. 2011 Jun. 38(6):588-92. [Medline].

 
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Histopathology of lupus miliaris disseminatus faciei showing nodule with caseation necrosis. Image courtesy of Dr. Dirk Elston.
Lupus miliaris disseminatus faciei central facial papules. Courtesy of San Antonio Uniformed Services Health Education Consortium.
Lupus miliaris disseminatus faciei.
 
 
 
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