Pathology of lupus miliaris disseminatus faciei

Lupus miliaris diseminatus faciei (LMDF) is a rare facial skin disease. It presents with pale papules that can be confused with sarcoid or syringoma clinically. Many authors now consider LMDF to be an extreme variant of granulomatous rosacea, rather than a mycobacterium infection as previously thought.

Histology of lupus miliaris diseminatus faciei

In LMDF, sections show round granulomas with central cassette necrosis. Granulomas may appear sarcoidal or tuberculoid. Granulomas usually arise adjacent to attached structures A chronic infiltrate Often accompanies granulomas. See figures 1-4.

Special studies for lupus miliaris diseminatus faciei

Mycobacterial and fungal infections can be ruled out with special stains (Ziehl Neelson and GMS respectively). PCR and culture Studies may be used if an infection is suspected.

Differential diagnosis of lupus miliaris diseminatus faciei

Granulomatous syphilis, deep fungal infection, leishmaniasis, tuberculosis – PCR and culture studies may be necessary for distinction in difficult cases.

Sarcoidosis: generally lacks caseante necrosis but it can show something fibrinoid Degeneration within the granulomas that can cause confusion.

Granulomatous Rosacea: Some authorities believe that LMDF is a form of rosacea. The degree of necrosis would be unusual for rosacea.