Lupus miliaris disseminatus faciei
The exact etiology of LMDF is unknown, but the current hypotheses include an inflammatory reaction to pilosebaceous units, injured hair follicles, or Cutibacterium acnes (formerly Propionibacterium acnes). It is also proposed that the activation of the IL-23 / IL-17 axis might be involved in the disease pathogenesis.
LMDF typically affects adolescents and adults of both sexes, although childhood cases and cases in elderly patients have also been reported. Lesions are usually asymptomatic and resolve spontaneously in 1-3 years with pitted scars. The eruption does not have known associations with any systemic diseases.
L93.2 – Other local lupus erythematosus
200932001 – Lupoid rosacea
Differential Diagnosis & Pitfalls
- – Evaluate for other clinical and laboratory findings of sarcoidosis; unlike LMDF, sarcoidosis is histologically characterized by noncaseating granulomas.
- – Other signs of rosacea such as flushing, erythema, and telangiectasias may be present; histopathology shows perifollicular noncaseating granulomas; does not regress spontaneously.
- – Testing such as serum QuantiFERON-TB Gold (QFT) or tuberculin skin testing may be indicated to rule out tuberculosis infection.
- – Involvement of lower eyelids suggests LMDF rather than acne vulgaris.
- Granulomatous periorificial dermatitis – Predominantly affects prepubertal children; biopsy shows perifollicular noncaseating granulomas.
- 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.
- Eruptive syringomas (see syringoma) – Skin biopsy may be useful to distinguish this entity from LMDF.