Lupus Miliaris Disseminatus Faciei Workup

Updated: Mar 06, 2020
  • Author: Dirk M Elston, MD; Chief Editor: William D James, MD  more...
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Workup

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. [8] 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 faci Histopathology of lupus miliaris disseminatus faciei showing nodule with caseation necrosis. Image courtesy of Dr. Dirk Elston.
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