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THROUGH THE DERMOSCOPE
Ahead of print publication  

Dermoscopy of lupus miliaris disseminatus faciei


 Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission26-Feb-2020
Date of Decision17-Apr-2020
Date of Acceptance01-Jun-2020
Date of Web Publication19-Sep-2020

Correspondence Address:
Aditi Dhanta,
Department of Dermatology, Venereology and Leprosy, All India Institute of Medical Sciences, Rishikesh - 249 203, Uttrakhand
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/idoj.IDOJ_114_20



How to cite this URL:
Dhanta A, Taneja G, Hazarika N. Dermoscopy of lupus miliaris disseminatus faciei. Indian Dermatol Online J [Epub ahead of print] [cited 2020 Nov 1]. Available from: https://www.idoj.in/preprintarticle.asp?id=295416

A 38- year-old male with fitzpatrick skin type IV presented with multiple, asymptomatic, reddish brown eruptions all over the face and ears that had evolved over a period of 3 months. He did not have photosensitivity or any other cutaneous or systemic complaints. Family history was unremarkable. Cutaneous examination revealed multiple, discrete, dome shaped erythematous to skin colored papules of varying size (1 mm to 5 mm) scattered over the bilateral cheeks, forehead, chin, and bilateral ears with few lesions showing scarring and crusting over nose and cheek [Figure 1]a and [Figure 1]b. Rest of the muco-cutaneous and systemic examination was noncontributory. Based on the history and clinical findings, a diagnosis of lupus miliaris disseminatus faciei and sarcoidosis were considered.
Figure 1: (a) Multiple, discrete, dome shaped erythematous to skin colored papules of varying scattered over the bilateral cheeks, forehead, chin.(b) Multiple erythematous papules present over cheek, forehead, and ear with few lesions showing crusting and scarring

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Dermoscopy of the erythematous lesions using DermLite DL200 hybrid- 3Gen; polarized mode, ×10 magnification revealed follicular plugs in the lesions, some resembling a target with peripheral radiating white streaks present over an orange-brown and erythematous background [Figure 2]a and [Figure 2]b. Only few linear vessels were seen. Histopathological examination of a skin biopsy taken from a representative lesion on the cheek revealed multiple hair follicles with inflammatory infiltrate present in the interstitium as well as around pilosebaceous units. Dermis showed area of caseous necrosis, surrounded by aggregates of epithelioid histiocytes and occasional multinucleated giant cells with lymphoid cell at periphery, extending into deeper dermis [Figure 3]a, [Figure 3]b, [Figure 3]c. Special stains such as acid-fast bacillus (AFB) and periodic acid schiff (PAS) were both negative. The histology findings were consistent with lupus miliaris disseminatus faciei. Patient started on cap doxycycline 100 mg twice daily and topical tacrolimus.{Figure 2}
Figure 2: (a) Dermoscopy under polarized mode using Dermalite DL200 hybrid- 3Gen showing central targetoid follicular plug (white arrow) with white streaks, few linear vessels (black arrow) present on a reddish- brown background (black circle).(b) Dermoscopy under polarized mode using Dermalite DL200 hybrid- 3Gen showing radiating white streaks (blue arrow) present on an orange- brown background (black circle)

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Lupus miliaris disseminatus faciei (LMDF) is an uncommon, inflammatory, and granulomatous disease of unknown etiology characterized by symmetrical, monomorphic, reddish-brown papules clustered around the eyelids and mouth besides involvement of forehead and cheeks. It is believed to be the result of an autoimmune reaction resulting from the rupture of hair follicles, which causes granulomatous disease.[1]

The dermoscopic features in our case are in line with those described previously by Ayhan et al.[2] Central targetoid follicular plug with white streaks present on an orangish brown background are seen in dermoscopy. Keratotic follicular plugs seen on dermoscopy develop as a result of lateral pressure on hair follicles.[3] They are absent in other differential diagnoses of LMDF, such as sarcoidosis and lupus vulgaris. The orangish brown structures in background represent granulomatous inflammation but are not specific as they can also be seen in other granulomatous disorders. The linear vessels were not well appreciated in our case because of darker skin type as compared to the study by Ayhan et al.[2]

LMDF needs to be differentiated from other facial granulomatous papules such as papular sarcoidosis, granulomatous rosacea, and granuloma faciale. The dermoscopic findings of differentials have been discussed in [Table 1].
Table 1: Dermoscopic findings of differentials of lupus miliaris disseminatus faciei

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Surprisingly, on detailed literature search we could come across a single case report focussing on dermoscopy in lupus miliaris disseminatus faciei. Thus, we wish to highlight the dermoscopic findings of LMDF, which can act as a supplementary tool in a physician's armamentarium to clinch the diagnosis of this difficult to diagnose granulomatous disorder.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.[5]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
El Darouti M, Zaher H. Lupus miliaris disseminatus faciei –pathologic study of early, fully developed, and late lesions. Int J Dermatol 1993;32:508-11.  Back to cited text no. 1
    
2.
Ayhan E, Alabalik U, Avci Y. Dermoscopic evaluation of two patients with lupus miliaris disseminatus faciei. Clin Exp Dermatol 2014;39:500-2.  Back to cited text no. 2
    
3.
Llambrich A, Zaballos P, Terasa F, Torne I, Puig S, Malvehy J. Dermoscopy ofcutaneous leishmaniasis. Br J Dermatol 2009;60:756-61.  Back to cited text no. 3
    
4.
Teixeira DA, Estrozi B, Ianhez M. Granuloma faciale: A rare disease from a dermoscopy perspective. An Bras Dermatol 2013;88(6 Suppl 1):97-100.  Back to cited text no. 4
    
5.
Errichetti E, Stinco G. Dermatoscopy of granulomatous disorders. Dermatol Clin 2018;36:369-75.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 3], [Figure 3]
 
 
    Tables

  [Table 1]



 

 
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