Lupus Miliaris Disseminatus Faciei Workup

  • Author: Jeffrey Meffert, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jul 13, 2011
 

Imaging Studies

Imaging is not indicated for lupus miliaris disseminatus faciei (LMDF) unless sarcoidosis is suspected.

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Other Tests

Tests are not indicated for lupus miliaris disseminatus faciei (LMDF) unless sarcoidosis is considered likely.

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Procedures

Skin biopsy may be necessary if the diagnosis of lupus miliaris disseminatus faciei (LMDF) is in doubt. Biopsy may help distinguish LMDF from the more common granulomatous rosacea, sarcoidosis, or benign adnexal neoplasms such as syringomas. Potential complications of biopsy are scarring, infection, or insufficient biopsy material for diagnosis.

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Histologic Findings

Early lupus miliaris disseminatus faciei (LMDF) lesions show superficial perivascular and periappendiceal lymphocytic infiltrates with a few histiocytes and neutrophils. Fully developed lesions show round granulomas, often with caseation necrosis.[6] The changes mimic miliary tuberculosis. Mixtures of sarcoidal and tuberculoid granulomas also may be seen. Late lesions show fibrosis with scattered lymphocytes, histiocytes, and neutrophils and also may be perifollicular and may show epidermal thinning. Note the image below.

Histopathology of lupus miliaris disseminatus faciHistopathology of lupus miliaris disseminatus faciei showing nodule with caseation necrosis. Image courtesy of Dr. Dirk Elston.
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Contributor Information and Disclosures
Author

Jeffrey Meffert, MD  Assistant 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, and Texas Dermatological Society

Disclosure: Nothing to disclose.

Specialty Editor Board

James Fulton Jr, MD, PhD  Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC

James Fulton Jr, MD, PhD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Laser Medicine and Surgery, Dermatology Foundation, International Society of Cosmetic and Laser Surgeons, and Skin Cancer Foundation

Disclosure: Vivant Pharmaceuticals Grant/research funds Consulting

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, Northside 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: 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, Association of Professors of Dermatology, North American Hair Research Society, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M 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, Ackerman Academy of Dermatopathology, New York

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. 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. 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. Jun 1987;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. Jun 2011;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.
 
 
 
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