147 Science Letters 2016 | Volume 4 | Issue 2 | Pages 147-149 Lupus Miliaris Disseminatus Faciei: A Case Report Afzaal Ahmed Bin Jameel, Bing Rong Zhou, Dan Luo* Department of Dermatology, The First Affiliated Hospital of Nanjing Medical University, 300-Guang Zhou Road, 210029, Nanjing, Jiangsu, China Abstract Lupus miliaris disseminaturs faciei (LMDF) is an inflammatory disease with an unknown etiology. It is characterized by the presence of several dome shaped monomorphic papules in the centro-lateral facial areas. Diascopy of relatively larger lesions often reveals an apple jelly like nodular appearance. Based on the typical clinical manifestations (reddish yellow papules localized in the central and lateral areas of the face, especially the eyelids) and histopathological findings (giant epitheloid granuloma with varying caseating necrosis) a diagnosis of LMDF can be established. Herein, we would like to present a typical case of LMDF in a 43-year-old Chinese female with a brief insight on the clinical features. The patient had used before antibiotic creams without obvious improvement. Based on the clinical and histo-pathological findings, a diagnosis of LMDF was made and use of medicines was suggested. Keywords Acnitis, acne agminata, facial idiopathic granulomas, lupus miliaris. Received March 17, 2016 Accepted May 29, 2016 Published August 15, 2016 *Corresponding author Dan Luo E-mail daniluo2005@163.com Tel +86-25-86796545 To cite this manuscript: Jameel AAB, Zhou BR, Luo D. Lupus miliaris disseminates faciei: a case report. Sci Lett 2016; 4(2):147-149. Introduction Lupus miliaris disseminatus faciei (LMDF) is an uncommon granulomatous, inflammatory disease of unknown etiology. It is also known as acne agminata, or Facial Idiopathic Granulomas with Regressive Evolution (FIGURE) [1]. It clinically manifests as reddish yellow papules localized to the central and lateral areas of the face, especially involving the eyelids. It usually manifests in adults (especially males) and can also be seen in elderly and pediatric age groups [1, 2]. The etio-pathogenesis of LMDF is currently unknown [3]. To date, about 200 cases have been reported worldwide [4] and we would like to present a typical case of LMDF in a 43-year old Chinese female patient. Cash report A 43-year-old Chinese female presented at our outpatient department with an asymptomatic facial rash for about a year. Physical examination revealed multiple monomorphic reddish yellow papules distributed prominently on the central and lateral areas of the face (forehead, eyebrows, eyelids, naso-labial gap, and perioral areas), most obviously on the lower eyelids (Fig. 1A) while the trunk and extremities remained unaffected. In the past three months, the patient had occasionally used some topical antibiotic creams without any obvious improvement. The patient was otherwise healthy and denied any significant past medical history. The patient also denied the presence of a similar skin rash or that of Tuberculosis in her family. Chest X-ray and other routine laboratory tests were within normal limits. The result for T-Spot-TB test was also negative. For further evaluation a skin biopsy of the facial papule was performed (Fig. 1B). Histo-pathological analysis of the biopsy specimen revealed a large clear-boundary epithelioid cell granuloma with central necrosis surrounded by a lymphocytic infiltrate (Fig. 2A and 2B). Based on the clinical and histo-pathological findings, a diagnosis of lupus miliaris disseminatus faciei (LMDF) was made. The patient was counseled and educated regarding the course of the disease and the possible outcomes. The patient was started on doxycycline 100 mg bid and topical tacrolimus ointment 0.1% bid for several months. However, the patient did not visit for further follow up. Discussion Lupus miliaris disseminatus faciei (LMDF) usually manifests as multiple reddish brown or yellowish brown dome shaped translucent papules that symmetrically involve the central and lateral areas of the face, especially the areas around the eyelids [4]. Diascopy of relatively larger lesions often reveals an apple jelly nodule like appearance. LMDF may also involve other sites such as neck, CASE REPORT OPEN ACCESS