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Lupus miliaris disseminatus faciei - Skin
See also in: External and Internal Eye
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Lupus miliaris disseminatus faciei - Skin

See also in: External and Internal Eye
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Contributors: Robert Stavert MD, MBA, Belinda Tan MD, PhD, Jeffrey D. Bernhard MD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
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Synopsis

Lupus miliaris disseminatus faciei (LMDF), also referred to as acne agminata and acnitis, is a relatively rare papular eruption of the face. Because of its characteristic granulomatous histology, LMDF was previously thought to be a variant of tuberculosis. Others have proposed that LMDF is a variant of granulomatous rosacea or sarcoidosis. However, today many consider it to be a distinct entity. Some authors have proposed use of the term facial idiopathic granulomas with regressive evolution (acronym FIGURE); however, this term has not been widely accepted.

LMDF typically affects adolescents and adults of both sexes. Lesions are usually asymptomatic and resolve spontaneously in 1-2 years with pitted scars. The eruption does not have any known associations with systemic disease.

Codes

ICD10CM:
L93.2 – Other local lupus erythematosus

SNOMEDCT:
397845003 – Granulomatous rosacea

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Sarcoidosis – Must evaluate for other clinical and laboratory findings of sarcoidosis.
  • Granulomatous rosacea (see rosacea) – Other signs of rosacea such as flushing, erythema, and telangiectasias may be present.
  • Lupus vulgaris (see cutaneous tuberculosis) – Testing such as serum QuantiFERON-TB Gold or tuberculin skin testing may be useful to evaluate for signs of tuberculosis infection.
  • Granulomatous periorificial dermatitis – Often responsive to tetracyclines.
  • Miliary and agminated type primary and cutaneous follicle center lymphoma (see cutaneous B-cell lymphoma) – Skin biopsy is useful to distinguish this entity from LMDF.
  • Acne vulgaris – Involvement of lower eyelids suggests LMDF rather than acne vulgaris. 
  • Polymorphous light eruption – Lesions are often pruritic and are always restricted to sun-exposed areas.
  • Seborrheic dermatitis – There is often dryness, pruritus, erythema, and fine, greasy scaling.
  • Eruptive syringomas (see syringoma) – Skin biopsy may be useful to distinguish this entity from LMDF.

Best Tests

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Therapy

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References

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Last Updated: 10/10/2013
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Lupus miliaris disseminatus faciei - Skin
See also in: External and Internal Eye
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Lupus miliaris disseminatus faciei : Face, Smooth papules
Clinical image of Lupus miliaris disseminatus faciei
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