ContentsSynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferencesView all Images (16)
Lupus miliaris disseminatus faciei
See also in: External and Internal Eye
Other Resources UpToDate PubMed

Lupus miliaris disseminatus faciei

See also in: External and Internal Eye
Contributors: Nazgol-Sadat Haddadi MD, MPH, Mehdi Rashighi MD, Robert Stavert MD, MBA, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Lupus miliaris disseminatus faciei (LMDF), also known 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 cutaneous tuberculosis, 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.

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.

Codes

ICD10CM:
L93.2 – Other local lupus erythematosus

SNOMEDCT:
200932001 – Lupoid rosacea

Look For

Subscription Required

Diagnostic Pearls

Subscription Required

Differential Diagnosis & Pitfalls

  • Sarcoidosis – Evaluate for other clinical and laboratory findings of sarcoidosis; unlike LMDF, sarcoidosis is histologically characterized by noncaseating granulomas.
  • Granulomatous rosacea – Other signs of rosacea such as flushing, erythema, and telangiectasias may be present; histopathology shows perifollicular noncaseating granulomas; does not regress spontaneously.
  • Lupus vulgaris – Testing such as serum QuantiFERON-TB Gold (QFT) or tuberculin skin testing may be indicated to rule out tuberculosis infection.
  • Acne vulgaris – 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.

Best Tests

Subscription Required

Management Pearls

Subscription Required

Therapy

Subscription Required

References

Subscription Required

Last Reviewed:05/10/2020
Last Updated:06/02/2020
Copyright © 2021 VisualDx®. All rights reserved.
Lupus miliaris disseminatus faciei
See also in: External and Internal Eye
Lupus miliaris disseminatus faciei : Smooth papules
Clinical image of Lupus miliaris disseminatus faciei
Multiple tiny, red-brown papules and pink erythema of the cheek.
Copyright © 2021 VisualDx®. All rights reserved.