|Year : 1992 | Volume
| Issue : 2 | Page : 102-104
Lupus miliaris disseminatus faciei report of 4 cases
RR Sule, NV Athavale, MB Gharpuray
R R Sule
Source of Support: None, Conflict of Interest: None
Lupus miliaris disseminatus faciei is an uncommon disease affecting face. Previously lupus miliaris disseminatus faciei was thought to be a tuberculid; but now it is considered as a granulomatuous variant fo acne rosacea. We report 4 cases; each having lesions on face but in 1 also on body. The cases had erythematous tiny popular lesions of varying chronicity of 4 months to 1 year. Investigations for tuberculosis were negative. Histopathology revealed tuberculoid granuloma. All patients responded to Erythromycin; except 1 required Chloroquine.
Keywords: Lupus miliaris disseminatus faciei
|How to cite this article:|
Sule R R, Athavale N V, Gharpuray M B. Lupus miliaris disseminatus faciei report of 4 cases. Indian J Dermatol Venereol Leprol 1992;58:102-4
|How to cite this URL:|
Sule R R, Athavale N V, Gharpuray M B. Lupus miliaris disseminatus faciei report of 4 cases. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2020 Apr 1];58:102-4. Available from: http://www.ijdvl.com/text.asp?1992/58/2/102/3762
| Introduction|| |
Lupus miliaris disseminatus faciei is an uncommon disease of acquired origin commonly affecting face. Originally lupus miliaris disseminatus faciei was thought to be a tuberculid.  In spite of tuberculoid pathology, tuberculin test is usually negative and mycobacteria cannot be cultured from the lesions. The term "Lupus miliaris disseminatus faciei" still persists but now it is considered as a granulomatous variant of acne rosacea. 
| Case Report|| |
Case 1 : A 35-year-old male labourer presented with erythematous papular lesions on face of 4'/ 2 months duration. On examination multiple erythematous firm papular lesions about 3-5mm in diameter were present on whole face including eyelids and perioral area and few lesions were present on neck. Few pustules and scars were also present [Figure - 1].
Case 2 : A 28-year-old male presented with papular lesions on face of 1 year duration. Clinical examination revealed numerous erythematous rounded dome shaped papular lesions of 4-8mm diameter on face. Few papules coalesced to form plaques on forehead. Papules were soft and non tender. General and systemic examination revealed no abnormality.
Case 3 : A 30-year-old lady clerk by occupation came for papular lesions on her face of 6 months duration. She had applied various ointments with no relief. On examination, she had erythematous discrete papules on forehead, nose, malar eminences, upper lip and chin. The papules were of 4 mm diameter, soft and non tender. Few depressed scars were seen suggesting old lesions.
Case 4: A 47-year-old housewife presented with papular lesions on face, neck and forearms for 1 year. The patient had received antitubercular treatment as combination of INH, rifampicin, ethambutol and pyrizinamide for 3 months without any response.
On examination, there were erythematous papules of 4-6mm diameter on forehead, eyelids, upper lip, chin, neck, forearms and elbows. The lesions were soft, slightly tender and showed crusting at places. General and systemic examination revealed no abnormality.
| Investigations|| |
In all four cases, haemogram, urine and chest X-ray were normal. Serum VDRL was nonreactive. Tuberculin test was negative; except in 2nd patient it was weakly positive. The culture of material from lesions on Lowenstein-Jensen medium produced no growth. Histopathology, in every case, showed tuberculoid granuloma in upper dermis, consisting of lymphocytes, epitheloid cells and Langhan's giant cells. There was no caseation in case 2 and 3 and minimal in case 1. AFB were not detected.
| Treatment|| |
First patient was given erythromycin 2 grams daily for two months which showed partial response. Later on, he was given erythromycin 1 gram daily with metronidazole 400 mg thrice-a-day and all lesions regressed within 3 months.
Second case was put on tetracycline 500 mg 4 times a day for two weeks, but with no response. Then he was given erythromycin 500 mg 4 times a day for 2 weeks and later erythromycin 250 mg 4 times a day for 2 months which showed good response.
Case no. 3 was given erythromycin 250 mg 4 times a day. She showed marked improvement within 3 weeks of therapy.
The last patient was given erythromycin 250mg 4 times a day for 1 month. There was no improvement. So she was kept on chloroquine sulphate 250mg twice a day. The patient showed excellent clinical response leading to recovery in one month period.
| Discussion|| |
The cause and pathogenesis of lupus miliaris disseminatus faciei is not known. Lupus miliaris disseminatus faciei is not a tuberculid because mycobacteria cannot be grown from the lesions, tuberculin test is negative and it does not respond to antitubercular treatment.  Lupus miliaris disseminatus faciei is now thought to be granulomatous variant of acne rosacea. Out of 4 cases seen, there were 2 males and 2 females; all were in age group of 30 to 50 which favours possibility of acne rosacea. In all 4 cases lesions were mainly present on face with involvement of eyelids and upper lip; only one case in addition showed lesions on extremities, which is rarely reported.  All cases showed typical tuberculoid type of granuloma on histopathology and tuberculin test was negative or weakly positive which confirmed the diagnosis of lupus miliaris disseminatus faciei.
The fourth case had received antitubercular treatment with 4 drugs for 3 months without any improvement which supports the view that lupus miliaris disseminatus faciei is not a tuberculid. Two cases responded to erythromycin, 1 case to metronidazole and last case to chloroquine. The predominance of lesions on face and response to chloroquine in 1 case may indicate role of photosensitivity in pathogenesis. Though it should be kept in mind that lesions are self resolving in 1to 2 years. The lesions resolved with pitted scars. 
Thus we conclude that if the papular eruption on face is encountered with tuberculoid histopathology, but without any evidence of M. tuberculosis; then the diagnosis of granulomatous acne rosacea that is lupus miliaris disseminatus faciei should be considered.
| References|| |
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|2.||Laymon C W. Lupoid rosacea. Arch Dermatol 1957; 63: 409-13 |
|3.||Simon N. Ist der lupus miliaris disseminatus tuberculoser Aetiologie? Hautarzt 1975; 26 : 625. [PUBMED] |
|4.||Moschella SL. Diseases of the mononuclear phagocytic system. In : Dermatology (Moschella S L, Hurley H J, eds), 2nd edn. W B Saunders Company, 1985; 945-6. |
|5.||Wolff, Gert Tapeiner, Mycobacterial diseases: Tuberculosis and Atypical mycobacterial infections. In: Dermatology in General Medicine (Fitzpatrick T B, Eisen A Z, et al, eds), 3rd edn. New york McGraw-Hill Book Company, 1987; 2168. |
[Figure - 1]