Nosology and therapeutic options for lupus miliaris disseminatus faciei

Abstract

Lupus miliaris disseminatus faciei (LMDF) is a distinctive facial eruption of a debatable nosology, unknown etiology and spontaneously resolving course albeit with scarring. The aim of this study was to present the clinico-histopathological features, the rationale for treating and therapeutic response in patients with LMDF treated with different agents, and to attempt to clarify its nosology. Clinical details and demographic data of 29 biopsy-proven cases of LMDF were studied. Laboratory work up included complete blood count, erythrocyte sedimentation rate, tuberculin testing, chest X-ray, serum calcium levels and serum angiotensin-converting enzyme levels. Special stains like Ziehl-Neelsen, periodic acid Schiff and reticulin staining were used, and acid-fast bacilli culture was performed in each patient. The patients were treated with oral minocycline, dapsone, prednisolone and isotretinoin as monotherapeutic agents, or with a combination of oral dapsone plus prednisolone, and oral dapsone plus topical tacrolimus. Six patients had extrafacial lesions. Histological analysis revealed three different patterns: tuberculoid granuloma with central caseation necrosis in 20 patients; sarcoidal-like granuloma in six patients; and non-specific localized perifollicular lymphohistiocytic infiltrate in three patients. Nine out of 11 patients treated with minocycline did not respond, whereas dapsone and low dose prednisone alone or in combination produced good results. Topical tacrolimus with dapsone in seven patients yielded excellent results. Early and judicious use of medicines can clear this condition without scarring. LMDF should be accepted as a distinct entity. Facial idiopathic granulomas with regressive evolution (FIGURE), an acronym suggested is an apt, self-explanatory and easy term for LMDF, with no connotation of tubercular etiology.