Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
Images in Dermatology
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Media and news
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Images
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Reviewers 2022
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Snippets
Special Article
Specialty Interface
Studies
Study Letter
Study Letters
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Review and Meta-Analysis
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Tables
Technology
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
Therapy Letters
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF

Translate this page into:

Letter to the Editor
2017:83:3;354-357
doi: 10.4103/0378-6323.203584
PMID: 28366924

Extrafacial lupus miliaris disseminatus faciei: A rare entity

Yogesh Namdev Kalyanpad, Atul Madhusudan Dongre, Prachi Vinayak Gole, Uday Sharadchandra Khopkar
 Department of Dermatology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

Corresponding Author:
Yogesh Namdev Kalyanpad
Department of Dermatology, Seth GS Medical College and KEM Hospital, Parel, Mumbai - 400 012, Maharashtra
India
yogesh.kalyanpad@gmail.com
How to cite this article:
Kalyanpad YN, Dongre AM, Gole PV, Khopkar US. Extrafacial lupus miliaris disseminatus faciei: A rare entity. Indian J Dermatol Venereol Leprol 2017;83:354-357
Copyright: (C)2017 Indian Journal of Dermatology, Venereology, and Leprology

Sir,

A 32-year-old man presented with multiple, asymptomatic, erythematous papules on the face for 6 months. The lesions gradually increased in size and number to involve the neck and both forearms over the last 2 months. There were no systemic symptoms. Examination showed multiple, discrete, non-tender, symmetrical, reddish-brown papules on the forehead, both cheeks, neck and eyelids [Figure - 1]. Erythematous papules and nodules were also present on the dorsum of the hands and extensor aspect of the forearms [Figure - 2]. There was no regional lymphadenopathy. Blood investigations such as complete blood count, erythrocyte sedimentation rate and hepatic and renal function tests were normal. Chest X-ray was normal and Mantoux test was negative.

Figure 1: Multiple, discrete, non-tender reddish-brown papules on the cheeks, forehead, nose and eyelids
Figure 2: Erythematous papulonodular lesions on the dorsum of hands and few on the extensor forearm

Biopsy was taken from a facial lesion as well as a lesion on the forearm. Histopathology of lesion from face showed central areas of caseation necrosis in the dermis with surrounding tuberculoid granulomatous infiltrate consisting of histiocytes, epithelioid cells, giant cells and lymphocytes [Figure - 3] and [Figure - 4]. Biopsy from the papule on the forearm showed similar histological features as seen in facial lesion [Figure - 5] and [Figure - 6]. Special stains for tubercle bacilli were negative. The patient was treated with doxycycline leading to resolution of the lesions leaving behind pitted scars over a period of 3 months of treatment [Figure - 7] and [Figure - 8].

Figure 3: Biopsy from facial papule showed epidermal hyperplasia with caseation necrosis and granulomatous infiltrate in the dermis (H and E, ×100)
Figure 4: Higher magnification showed caseation necrosis surrounded by tuberculoid granulomas consisting of histiocytes, epithelioid cells, giant cells and lymphocytes (H and E, ×200)
Figure 5: Histopathology of the lesion on the forearm showing foci of caseation necrosis with granulomatous infiltrate in mid and deep dermis (H and E, ×100)
Figure 6: Caseation necrosis surrounded by granulomas consisting of epithelioid cells, giant cells and lymphocytes (H and E, ×200)
Figure 7: Lesions resolving with multiple varioliform scars with some papules in periorbital region
Figure 8: Resolution of lesions with scarring on the dorsum of the right hand

Lupus miliaris disseminatus faciei is an uncommon, chronic, inflammatory dermatosis characterized by multiple, monomorphic, symmetrical, reddish-brown papules on chin, forehead, cheeks and eye lids. The lesions usually regress spontaneously within months to some years leaving behind depressed scars.

Histopathologically, it is characterized by a dermal granulomatous infiltrate with a central area of caseation necrosis. Histopathological findings range from perivascular and periadnexal lymphohistiocytic infiltrate in early lesions and epithelioid cell granuloma with or without central necrosis in well-developed lesions. Late lesions show extensive perifollicular fibrosis with non-specific cell infiltration.

The exact etiopathogenesis of this condition is unclear. Earlier it was thought to be a “tuberculid,” but it is no longer thought to be of tuberculous origin. It is hypothesized that the condition is due to immune response to the follicular antigens that are released due to damage to the hair epithelium, triggering an autoimmune reaction directed against hair-follicles. Other authors consider it to be a variant of granulomatous rosacea due to the centrofacial distribution and granulomatous histopathology. However, some believe that it is an entity distinct from either skin tuberculosis or granulomatous-type rosacea and propose to change its name to “facial idiopathic granulomas with regressive evolution.”[1]

Various treatments have been advocated and these include tetracycline, prednisolone and isotretinoin. Isoniazid and dapsone have also been reported to be useful.[2]

Face is a common site for lupus miliaris disseminatus faciei lesions and extrafacial involvement is rarely seen, with only a few reports of the latter. Extrafacial sites reported include axillae, neck, scalp, legs, trunk and genitalia. Kou et al. have described extrafacial distribution of lesions without face involvement.[3]

Nath et al. have reported the extensive involvement of the face with unusual linvolvement of the ear lobes, neck and the shoulder girdle in an Indian patient.[4] A case of extrafacial lupus miliaris disseminatus faciei alongwith Morbihan disease and with axillary acneagminata has been reported.[3] However, in our patient, these associations were not seen. Bedlow has described a case of two adults with involving axillae with no facial lesions.[5]

We report this case to emphasize the relatively rare extrafacial distribution of lupus miliaris disseminatus faciei involving the dorsae of hands and forearms.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References
1.
Skowron F, Causeret AS, Pabion C, Viallard AM, Balme B, Thomas L. F.I.GU.R.E.: Facial idiopathic granulomas with regressive evolution. Is 'lupus miliaris disseminatus faciei' still an acceptable diagnosis in the third millennium? Dermatology 2000;201:287-9.
[Google Scholar]
2.
Kumano K, Tani M, Murata Y. Dapsone in the treatment of miliary lupus of the face. Br J Dermatol 1983;109:57-62.
[Google Scholar]
3.
Kou K, Chin K, Matsukura S, Sasaki T, Nozawa A, Aihara M, et al. Morbihan disease and extrafacial lupus miliaris disseminatus faceie: A case report. Ann Saudi Med 2014;34:351-3.
[Google Scholar]
4.
Nath AK, Sivaranjini R, Thappa DM, Basu D. Lupus miliaris disseminatus faciei with unusual distribution of lesions. Indian J Dermatol 2011;56:234-6.
[Google Scholar]
5.
Bedlow AJ, Otter M, Marsden RA. Axillary acne agminata (lupus miliaris disseminatus faciei). Clin Exp Dermatol 1998;23:125-8.
[Google Scholar]

Fulltext Views
2,889

PDF downloads
1,468
Show Sections