Lupus Miliaris Disseminatus Faciei

Abstract

A woman in her 40s presented with a year history of an asymptomatic, expanding papular eruption on the face. She denied any systemic symptoms. Physical examination revealed multiple small, symmetrical, reddish brown papules on her cheeks, nose, and eyelids (Figure). Skin biopsy results showed multiple perifollicular epithelioid cell granulomas, with central areas of necrosis. Staining for fungi and acid-fast bacilli yielded negative results. A computed tomography scan of the chest, complete blood cell count, and metabolic panel were normal. A diagnosis of Lupus miliaris disseminatus faciei (LMDF) was made. The patient was refractory to treatment with systemic corticosteroids, doxycycline, and oral isotretinoin. Eight months of treatment with oral dapsone (100 mg/day) produced substantial clinical improvement that was maintained at 6-month and 1-year follow-up visits