Lupus Miliaris Disseminatus Faciei Medication
- Author: Jeffrey Meffert, MD; Chief Editor: Dirk M Elston, MD more...
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.
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 may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity.
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'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'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's anti-inflammatory effects may result from the inhibition of inflammatory cell migration and transformation of lymphocytes.
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 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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