eMedicine Specialties > Dermatology > Diseases of the Adnexa

Lupus Miliaris Disseminatus Faciei: Treatment & Medication

Author: Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Contributor Information and Disclosures

Updated: Jan 29, 2009

Treatment

Medical Care

A variety of medical treatments reportedly are effective in lupus miliaris disseminatus faciei (LMDF), although controlled studies that support one treatment or group treatments as optimal are lacking. Reported therapies include the following:

  • Low-dose prednisone7
  • Intramuscular triamcinolone
  • Dapsone
  • Tetracycline products
  • Antimalarials
  • Pyridoxine hydrochloride
  • Riboflavin
  • Isotretinoin8

Surgical Care

  • Scar revision procedures (laser resurfacing, dermabrasion, chemical peel) may benefit patients after the disease has run its course.
  • Treatment with the 1450-nm diode laser has been reported to be effective.
  • Pulse-dye laser has been used to successfully treat the erythema of rosacea, but its use in this condition has not been described.

Consultations

No consultations are indicated.

Diet

No dietary association (excess or deficiency) with LMDF is described.

Activity

No physical activities or exposures are described that either improve or worsen LMDF.

Medication

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.

Corticosteroids

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)

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

Adult

Standard dose: 1 mg/kg/d; taper after LMDF resolves
Low dose: 10 mg qd for 2 wk, followed by 5 mg qd for 3 mo

Pediatric

Not established

Coadministration with estrogens may decrease prednisone clearance; concurrent use with digoxin may cause digitalis toxicity secondary to hypokalemia; phenobarbital, phenytoin, and rifampin may increase metabolism of glucocorticoids (consider increasing maintenance dose); monitor for hypokalemia with coadministration of diuretics

Documented hypersensitivity; viral infection, peptic ulcer disease, hepatic dysfunction, connective tissue infections, and fungal or tubercular skin infections, GI disease

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Abrupt discontinuation of glucocorticoids may cause adrenal crisis; hyperglycemia, edema, osteonecrosis, myopathy, peptic ulcer disease, hypokalemia, osteoporosis, euphoria, psychosis, myasthenia gravis, growth suppression, and infections may occur

Tetracyclines

Used for their anti-inflammatory rather than antibiotic effects. Most reports describe limited therapeutic benefit.

Class includes tetracycline, doxycycline, and minocycline.


Tetracycline (Sumycin)

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

Adult

250-500 mg PO bid/qid

Pediatric

<8 years: Not recommended
>8 years: 25-50 mg/kg/d (10-20 mg/lb) PO qid; 1 h ac or 2 h pc

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can increase hypoprothrombinemic effects of anticoagulants; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment, especially with doxycycline; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; use during tooth development (last one half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines


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

Anti-inflammatory effect may result from inhibition of migration of inflammatory cells and transformation of lymphocytes. Inhibits protein synthesis and thus bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

Adult

50-100 mg PO bid

Pediatric

<8 years old: Not recommended
>8 years old: Administer as in adults

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; tetracyclines can increase hypoprothrombinemic effects of anticoagulants; tetracyclines can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one-half of pregnancy through age 8) can cause permanent discoloration of teeth; Fanconi-like syndrome may occur with outdated tetracyclines


Minocycline (Dynacin, Minocin)

Anti-inflammatory effects may result from inhibition of inflammatory cell migration and transformation of lymphocytes.

Adult

50-100 mg PO bid

Pediatric

<8 years: Not recommended
>8 years: 50 mg PO qd/tid

Bioavailability decreases with antacids containing aluminum, calcium, magnesium, iron, or bismuth subsalicylate; can decrease effects of oral contraceptives, causing breakthrough bleeding and increased risk of pregnancy; tetracyclines can increase hypoprothrombinemic effects of anticoagulants

Documented hypersensitivity; severe hepatic dysfunction

Pregnancy

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Photosensitivity may occur with prolonged exposure to sunlight or tanning equipment; reduce dose in renal impairment; consider drug serum level determinations in prolonged therapy; tetracycline use during tooth development (last one-half of pregnancy through age 8 y) can cause permanent discoloration of teeth; Fanconilike syndrome may occur with outdated tetracyclines; hepatitis or lupus-like syndromes may occur

Retinoids

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)

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.
Should be prescribed only by physicians experienced and/or trained in its use.

Adult

0.5-1 mg/kg/d PO

Pediatric

Not established

Toxicity may occur with vitamin A coadministration; pseudotumor cerebri or papilledema may occur when coadministered with tetracyclines; may reduce plasma levels of carbamazepine

Documented hypersensitivity; pregnancy or intended pregnancy within 3 mo

Pregnancy

X - Contraindicated; benefit does not outweigh risk

Precautions

Causes skin and mucosal dryness; patient may not be able to wear contact lenses while undergoing therapy; depression and other behavior changes are associated with use; monitor lipids (particularly triglycerides) and LFTs; advise patients to avoid pregnancy while undergoing therapy and for a minimum of 3 mo after discontinuation; nay decrease night vision; inflammatory bowel disease may occur; may be associated with development of hepatitis; diabetes patients may experience problems in controlling their blood sugar while on isotretinoin; avoid exposure to UV light or sunlight until tolerance achieved; discontinue treatment if rectal bleeding, abdominal pain, or severe diarrhea occur

More on Lupus Miliaris Disseminatus Faciei

Overview: Lupus Miliaris Disseminatus Faciei
Differential Diagnoses & Workup: Lupus Miliaris Disseminatus Faciei
Treatment & Medication: Lupus Miliaris Disseminatus Faciei
Follow-up: Lupus Miliaris Disseminatus Faciei
Multimedia: Lupus Miliaris Disseminatus Faciei
References
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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. Oct 1997;137(4):614-9. [Medline].

  4. Shitara A. Lupus miliaris disseminatus faciei. Int J Dermatol. Oct 1984;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. Jul 2005;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. Jul 1993;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. Jun 1996;134(6):1098-100. [Medline].

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

  9. Mihara K, Isoda M. Immunohistochemical study of lysozyme in lupus miliaris disseminatus faciei. Br J Dermatol. Aug 1986;115(2):187-92. [Medline].

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Further Reading

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Keywords

lupus miliaris disseminatus faciei, LMDF, acne agminata, acnitis

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Contributor Information and Disclosures

Author

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

Medical Editor

James Fulton Jr, MD, PhD, Medical Director, Fulton Skin Institute
James Fulton Jr, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Cosmetic Surgery, American Academy of Dermatology, Phi Beta Kappa, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Jeffrey J Miller, MD, Associate Professor of Dermatology, Penn State University College of Medicine; Staff Dermatologist, Penn 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, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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