LUPUS MILIARIS DISSEMINATUS FACIEI PDF

Lupus miliaris disseminatus faciei (LMDF) is a granulomatous eruption characterized by monomorphic, reddish-brown papules and nodules predominantly. A biopsy specimen revealed epithelioid cell granulomas with central necrosis, consistent with a diagnosis of lupus miliaris disseminatus faciei (Figure 2). Lupus miliaris disseminatus faciei (LMDF) first described in is an uncommon dermatosis of unknown etiology with characteristic.

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Copyright American Medical Association. A year-old white woman presented with a 3-year history of brown-red papules on miliarsi forehead, cheeks, nose, and chin Figure 1. The lesions were initially treated with topical metronidazole cream, without facuei. A biopsy specimen revealed epithelioid cell granulomas with central necrosis, consistent with a diagnosis of lupus miliaris disseminatus faciei Figure 2.

Oral minocycline therapy mg twice a day was initiated but was discontinued shortly thereafter because of drug-induced urticaria. Lesions of lupus miliaris disseminatus faciei before treatment A and after 3 treatments B with the nm diode laser. A, Well-demarcated, indurated, reddish-brown papules on the cheek before laser treatment.

B, Resolution of papules after 3 treatments with the laser. Low A and high B magnification of a biopsy specimen from a cheek diszeminatus. Lupus miliaris disseminatus faciei is a rare dermatologic disease that is characterized clinically by the presence of discrete, red-brown, dome-shaped papules on the face that resolve with pitted scars. It responds poorly to treatment with oral tetracycline-class antibiotics and oral isotretinoin, which are considered the mainstay of treatment.

Our patient could not tolerate tetracycline-class antibiotics, and her disease was resistant to treatment with several systemic agents, including erythromycin, isotretinoin, and prednisone. This left few, if any, established treatments for her condition, which remained active. Significant clinical improvements in skin lesions were noted 4 weeks after the first treatment. Two additional treatments were administered at monthly intervals, with continued improvement Figure 1.

Complete resolution of skin lesions was noted by the third treatment. Five months after the last treatment, the patient remained clear of disease, without any flares and without the use of any topical or oral medications. The only treatment-related adverse effects were treatment-site erythema and edema that lasted 1 to 2 days. No scarring or pigmentary alterations were associated with treatment.

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Lupus miliaris disseminatus faciei pathology

Lupus miliaris disseminatus faciei is a rare dermatologic disease that is characterized clinically by the presence of discrete, red-brown, dome-shaped papules on the face. Residual pitted scars are a characteristic feature of this disease.

The following histologic features are also characteristic: The etiology of this condition is unclear. Some authors consider it to be a variant of granulomatous rosacea, 1 – 4 while others believe that it is a distinct clinical entity. Overall, clinical response to all treatments has been poor. Although its pathogenesis and nature are not completely understood, lupus miliaris disseminatus faciei shares several common features with both acne vulgaris and rosacea.

The inflammatory lesions are located on the face, where the density of pilosebaceous units is highest. Also, the lesions respond to treatments that are often used for acne vulgaris and rosacea and may result in ice-pick scarring that is indistinguishable from that seen in acne vulgaris.

Lupus miliaris disseminatus faciei

There is often a periorbital and perioral component that is similar to that seen in acne vulgaris and rosacea as well. However, lupus miliaris disseminatus faciei is distinguished histologically by more intense granulomatous inflammation, which is often associated with caseating necrosis in the absence of an apparent infectious origin. The nm diode laser has recently been shown to be effective in the treatment of active disseminayus acne lesions on the back and face.

The nm diode laser would presumably also be effective in the treatment of the inflammatory and soft tissue forms of rosacea by targeting hair follicles and sebaceous glands and by reducing associated inflammation and fibrosis.

There are a number of possible mechanisms by which the nm diode laser can improve lupus miliaris disseminatus faciei. This laser has been shown to target pilosebaceous units, perhaps reducing the production of proinflammatory agents that may underlie lupus miliaris disseminatus faciei. Moreover, bacteriostatic effects resulting from dermal thermal damage may reduce offending bacteria that potentiate granuloma formation in conditions such as granulomatous rosacea and possibly lupus miliaris disseminatus faciei.

In conclusion, the nm diode laser should be considered for the treatment of lupus miliaris disseminatus faciei not only because of the chronic nature of the disease but also because of its tendency to result in permanent scarring, especially in cases that are resistant to standard medical care, as in the case reported herein. Clinicians, local and regional societies, residents, and fellows are invited to submit cases of challenges in management dissemijatus therapeutics to this section.

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Cases should follow eisseminatus established pattern. Submit 4 double-spaced copies of fackei manuscript with right margins nonjustified and 4 sets of the illustrations. Photomicrographs and illustrations must be clear and submitted as positive color transparencies mm slides or black-and-white prints.

Do not submit color prints unless accompanied by original transparencies. Lupus Miliaris Disseminatus Faciei: Treatment With the nm Diode Laser. Privacy Policy Terms of Use. Friedman, MD ; Sharon R. Hymes, MD ; Leonard H. Report of a case.

LUPUS MILIARIS DISSEMINATUS FACIEI WITH UNUSUAL DISTRIBUTION OF LESIONS

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LUPUS MILIARIS DISSEMINATUS FACIEI WITH UNUSUAL DISTRIBUTION OF LESIONS

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