HomeHealth articleslupus miliaris disseminatus facieiWhat Is Lupus Miliaris Disseminatus Faciei?

Lupus Miliaris Disseminatus Faciei

Verified dataVerified data
0

4 min read

Share

Lupus miliaris disseminatus faciei is a skin disorder showing red to yellow or yellow to brown papules on the center of the face, mainly around the eyelids.

Written by

Dr. Swathi. R

Medically reviewed by

Dr. Nidhin Varghese

Published At December 29, 2022
Reviewed AtFebruary 6, 2023

Introduction:

Lupus miliaris disseminatus faciei is an uncommon inflammatory skin disease characterized by red-to-yellow or yellow-to-red papules of the face, mostly around the eyelids. Lesions may occur singly or in crops. Once, it was considered tuberculid because of its histology. It is considered an extreme variant of granulomatous rosacea. It is a granulomatous disease affecting facial skin primarily where the lesion resolves spontaneously within several years but can leave scarring in the affected area. It shares overlapping features with other granulomatous dermatoses, including sarcoidosis and rosacea. It is unknown whether antigenicity of the hair follicle or the sebaceous gland structures with subsequent T cell-mediated destruction or other disruption of the pilosebaceous unit (hair follicle, hair shaft, and sebaceous gland composed together). Fibrosis is seen in lesions, correlating with clinical scar formation. Significant histologic overlap exists with granulomatous rosacea and other granulomatous disorders that affect the face. Since the lesions present in this disease are caused due to unknown factors, these papules or nodules can be attributed to the facial skin, where the eyelids are mainly involved along with the cheeks. All these about this disease were discussed in this article.

Who Gets Lupus Miliaris Disseminatus Faciei?

The patient presents with an abrupt onset of symptomatic red, yellow, brown, or skin-colored papules or nodules that are occasionally pustular and symmetrically attributed predominantly to the facial skin, where the lower eyelids are mainly involved, along with the involvement of the cheeks, forehead, nose, upper lips, ears, chin, or neck joint. Extra facial involvement is uncommon but sometimes includes the trunk, extremities, and genital skin. Similar to other granulomatous facial eruptions, it is often postulated that initial immune-mediated damage to the hair follicle leads to subsequent rupture of the follicle and an allergic or foreign body granulomatous response to keratin, sebum, or microbial components of the serum.

What Is the Cause of Lupus Miliaris Disseminatus Faciei?

Lupus miliaris disseminatus faciei is caused by unknown factors. The term tuberculid was used for reactive conditions associated with tuberculosis. Lupus miliaris disseminatus faciei is not associated with pulmonary tuberculosis and does not generally respond to anti-tuberculosis medicine. Tuberculin skin testing is often negative in these patients. This disease is most commonly seen in young adults and rare in older adults. A clear gender prediction has not been established, though in retrospective review, the average age of females is 43 years, and male patients 23 years old, and all patients beyond their mid-30s were female.

What Are the Clinical Features of Lupus Miliaris Disseminatus Faciei?

Lupus miliaris disseminatus faciei is an uncommon facial dermatosis.

  • It is presented with papules.

  • It is 1 to 3 mm monomorphous.

  • Smooth surface bumps are present.

  • Not only the nose and cheeks but also the lateral areas below the lower jaw are affected.

  • Rarely seen in the axilla.

  • Eyelid skin is involved mostly.

  • Heals with scarring.

  • Lesions may occur in single or in crops.

How Does the Lesion Look Under a Microscope?

Under the microscope, the histologic hallmark of lupus miliaris disseminatus faciei is a granulomatous infiltrate, in some cases centered around hair follicle structures. Both sarcoid (non-caseating) and tuberculoid (with central caseation necrosis) granulomas have been observed. They have diffuse infiltration of lymphocytes and histiocytes without well-formed granulomas. Characteristic of early lesions and may also demonstrate a peri-adnexal pattern. Accompanying neutrophils with or without neutrophilic microabscesses has been observed. Fibrosis is seen in late lesions, correlating with clinical scar formation. Significant histologic overlap exists with granulomatous rosacea and other granulomatous disorders affecting the face.

How Is Lupus Miliaris Disseminatus Faciei Diagnosed?

Patients often present with a relatively abrupt onset of asymptomatic yellow, red, brown, or skin-colored papules or nodules, which are occasionally pustular and symmetrically distributed predominantly on facial skin. The lower eyelids are most characteristically involved, and involvement of the forehead, cheeks, nose, upper lips, ears, chin, or neck is joint. Extra facial involvement is uncommon but reported in some cases, including on the trunk, extremities, and general skin.

Symmetrically distributed inflammatory papules or pustules are seen. They can be examined under microscopy. Triggers include steroid use, sunlight, alcohol, or spicy foods. Serum calcium and angiotensin-converting enzyme levels in their workup, with or without chest X-ray and ophthalmic exam, to help exclude sarcoidosis. Serological assays for tuberculosis and treponemal infection may also be considered.

What Is the Treatment Plan for Lupus Miliaris Disseminatus Faciei?

Treatment is usually unsatisfactory. Tetracyclines (Doxycycline and Minocycline) are usually the first line of treatment, but they are not consistently effective. Systemic treatment is effective in some patients where long-term therapy using Minocycline, Isotretinoin, Dapsone, Corticosteroids, and Clofazimine may be used. Anti-tuberculosis drugs alone or in association with Tetracyclines and Metronidazole are used. In addition, laser therapy uses a 1450 nm diode laser and a 1565 nm non-fractionated ablative laser resurfacing. Successful management includes combining 100% trichloroacetic acid and carbon dioxide lasers.

What Is the Differential Diagnosis of Lupus Miliaris Disseminatus Faciei?

  • Granulomatous Syphilis - An inflammation in secondary syphilis.

  • Deep Fungal Infection - A type of life-threatening opportunistic infection.

  • Leishmaniasis - A parasitic disease that affects the entire body.

  • Tuberculosis - A severe infective disease that mainly affects the lungs.

  • Sarcoidosis - A disease involving an abnormal collection of inflammatory cells.

  • Granulomatous Rosacea - Characterized by an eruption of yellowish-brown pimples over the face.

What Are the Prognosis and Complications?

Lupus miliaris disseminatus faciei is a limited skin disease where the history is limited and spontaneous evolution is over months to several years, within a mean duration of 18 months in one series. The primary long-term complication is facial scarring, which is significant and disfiguring. Early treatment may prevent or minimize significant scarring that is caused by the lesion in the area that is affected by the disease lupus miliaris disseminatus.

Conclusion:

Lupus miliaris disseminatus faciei is managed by an interprofessional team approach to improve the outcomes. Primary healthcare providers and dermatologists were involved. Some treatment options, including Dapsone and systemic corticosteroids, require careful education and monitoring of the patient with lupus miliaris disseminatus. Treating these lesions caused by lupus miliaris disseminatus faciei as early as possible may prevent and control the progression of the disease.

Source Article IclonSourcesSource Article Arrow
Dr. Nidhin Varghese
Dr. Nidhin Varghese

Dermatology

Tags:

lupus miliaris disseminatus faciei
Community Banner Mobile
By subscribing, I agree to iCliniq's Terms & Privacy Policy.

Source Article ArrowMost popular articles

Do you have a question on

lupus miliaris disseminatus faciei

Ask a doctor online

*guaranteed answer within 4 hours

Disclaimer: No content published on this website is intended to be a substitute for professional medical diagnosis, advice or treatment by a trained physician. Seek advice from your physician or other qualified healthcare providers with questions you may have regarding your symptoms and medical condition for a complete medical diagnosis. Do not delay or disregard seeking professional medical advice because of something you have read on this website. Read our Editorial Process to know how we create content for health articles and queries.

This website uses cookies to ensure you get the best experience on our website. iCliniq privacy policy