Lupus miliaris disseminatus faciei

A 36-year-old woman presented to our clinic with a two-month history of progressively appearing multiple papular lesions on the face. The patient reported that the lesions were completely asymptomatic but sought consultation due to their unsightly appearance. She denied any relevant past medical history. On physical examination, numerous erythematous to brownish papules, 3–4 mm in diameter, were observed in the periorbital region, on the cheeks, and on the upper lip (Fig. 1). Some lesions displayed a slightly yellowish center. Histopathological analysis revealed granulomas in the upper dermis, composed of a palisade of epithelioid histiocytes surrounding a central area of necrosis. The epidermis was spared, although mild spongiosis was noted. Ziehl–Neelsen staining showed no acid-fast bacilli, and culture of a small tissue sample in medium suitable for mycobacteria yielded negative results. Based on these clinical and histopathological findings, a diagnóstico of lupus miliaris disseminatus faciei was made. The patient was started on isotretinoin 20 mg/day after confirming normal thyroid function, lipid profile, and liver function tests. After six months of treatment, the lesions resolved completely.

Fig. 1.

General appearance of numerous small reddish-brown, papules disseminated proportionally on the central face.

Declarations of interest

None.

Ethical consideration

Patient written informed consent was obtained.

Funding

There was no funding or financial support in the creation of this clinical image.

Ethical committee

Comité de Investigación de la UDEM.

Registry number: 18092024-CARD-CI.