The Clinical and Histopathologic Features of 30 Cases of Lupus Miliaris Disseminatus Faciei

Han, Jung Hyun; Yun, Sook Jung; Lee, Jee Bum; Kim, Seong Jin; Lee, Seung Chul; Won, Young Ho

Abstract

BACKGROUND
Lupus miliaris disseminatus faciei (LMDF) is a rare granulomatous disease characterized by eruption of discrete red-brown, dome-shaped papules, predominantly in the lower eyelid. Histopathologically, LMDF could present as caseous necrosis in the central area with granulomas composed of epithelioid cells and giant cells. The pathogenesis of LMDF remains controversial. Some suspect LMDF as a kind of cutanoeus tuberculosis, but others believe LMDF to be a variant of granulomatous rosacea or sarcoidosis.
OBJECTIVE
This study aimed to investigate the clinical and histopathologic features of LMDF.
METHODS
We reviewed the medical records, clinical photographs, and histopathologic slides of 30 cases of LMDF that were evaluated in our department between February 1991 and May 2009.
RESULTS
The average age of the affected patient was 34.6+/-10.9 years and the ratio of male-to-female patients was 3.3 : 1. The most common sites of involvement with LMDF was the eyelid (86.7%). cheek (76.7%), philtrum (60.0%), and glabella (56.7%). On histopathologic examination, the epithelioid granulomas had a connection to pilosebaceous structures in 66.7% of the cases. Follicular rupture (33.3%), perifollicular granulomas composed of naked tubercles (53.2%), and sarcoidal granulomas with abscesses (23.3%) were noted. Characteristic caseous necrosis occurred in 7 cases (23.3%). The duration of LMDF was 2 years in 26 cases (86.7%) and the lesion improved leaving scar in 21 cases (70%).
CONCLUSION
We identified the histopathologic changes of LMDF as a function of disease duration. Connections of pilosebaceous units with granulomas were commonly observed. It will be helpful to understand the pathophysiology of LMDF.