10.5826/dpc.1201a17
text/xml
2160-9381
1731
en
Nikhil Mehta
https://creativecommons.org/licenses/by-nc/4.0
Dermatology Practical & Conceptual
dermatoscopy
Dermoscopy of Lupus Miliaris Disseminatus Faciei Lesions in Different Stages of Evolution
Text.Serial.Journal
https://dpcj.org/index.php/dpc
Research Letter
2022-02-02
2021-03-29
2022-02-02
2022-02-09
e2022017
Dermatol Pract Concept
Nikhil Mehta
2022/02/02
10.5826/dpc.1201a17
e2022017
Department of Dermatology and Venereology, All India Institute of Medical Sciences, Delhi, India
2160-9381
dermatoscopy
en
e2022017
Chauhan P, Jindal R, Shirazi N. Dermoscopy of lupus miliaris disseminatus faciei: a step closer to diagnosis. Dermatol Pract Concept. 2020;10(3):e2020055. DOI: 10.5826/dpc.1003a55. PMID: 32685274; PMCID: PMC7346596.
Dermoscopy of Lupus Miliaris Disseminatus Faciei Lesions in Different Stages of Evolution
https://dpcj.org/index.php/dpc/article/download/1731/1474
                    Dermatology Practical & Conceptual


  Dermoscopy of Lupus Miliaris Disseminatus Faciei
      Lesions in Different Stages of Evolution
                                             Pankhuri Dudani1, Nikhil Mehta1


1 Department of Dermatology and Venereology, All India Institute of Medical Sciences, Delhi, India



Key words: dermatoscopy, lupus miliaris disseminatus faciei, telangiectasia, in-focus vessels, varioliform scar
Citation: Dudani P, Mehta N. Dermoscopy of lupus miliaris disseminatus faciei lesions in different stages of evolution.
Dermatol Pract Concept. 2022;12(1):e2022017. DOI: https://doi.org/10.5826/dpc.1201a17
Accepted: May 26, 2021; Published: January 2022
Copyright: ©2022 Dudani and Mehta. This is an open-access article distributed under the terms of the Creative Commons Attribution-
NonCommercial License (BY-NC-4.0), https://creativecommons.org/licenses/by-nc/4.0/, which permits unrestricted noncommercial use,
distribution, and reproduction in any medium, provided the original authors and source are credited.
Funding: None.
Competing interests: None.
Authorship: Both authors have contributed significantly to this publication.
Corresponding author: Nikhil Mehta, MD, Department of Dermatology and Venereology.
All India Institute of Medical Sciences, Delhi, India. E-mail: nikhilmehtadermatology@gmail.com




Introduction                                                              but were also seen centrally. Few lesions showed a central
                                                                          white stellate region. Early depressed scars showed in-fo-
Lupus miliaris disseminatus faciei (LMDF) is an uncommon                  cus marginal telangiectasias (Figure 1, B and E). Elongated
chronic granulomatous disease of the head and neck re-                    plaques over neck showed similar features of yellow-red
gion. Its dermoscopic features have recently been described,              structureless areas and white areas suggestive of early
mainly in Fitzpatrick skin-types 2 and 3. Its etiology is un-             scarring in a linear pattern, along with short linear and
known, and adults between the second and fourth decades                   branching vessels arranged radially (Figure 1, C and F). His-
of life are affected most.                                                topathology showed multiple perifollicular necrotizing epi-
                                                                          thelioid cell granulomas in the dermis consistent with LMDF
                                                                          (Figure 2, A and B).
Case Presentation
A 35-year-old man, Fitzpatrick skin-type 4, presented with
                                                                          Conclusions
asymptomatic yellowish-to-red-colored papules over the
forehead, eyelids, nose, and ear helices; and elongated plaques           LMDF presents as multiple skin-colored to erythematous
over the neck, for 5 months. Many lesions had healed with                 fleshy papules and plaques over cheeks, periocular and peri-
depressed varioliform and boxcar-like scars. Dermoscopy of                oral regions, especially over eyelids and earlobes. At neck,
dome-shaped active papules showed structureless yellow-red                they present as elongated plaques. Lesions resolve sponta-
areas, follicular plugs, and in-focus telangiectasias (Figure 1,          neously in 1-2 years or faster with treatment, leaving de-
A and D). The latter were most prominent peripherally                     pressed, atrophic, varioliform scars.




Research Letter | Dermatol Pract Concept. 2022;12(1):e2022017                                                                        1
    Figure 1. (A) Erythematous to skin-colored papules over upper and lower eyelid, with middle papule showing
    central depression. (B) Multiple depressed erythematous scars over the right cheek. (C) Linear erythematous
    elevated plaques over the right side of neck with background erythema. (D) Dermoscopy of lesions circled
    in A, showing follicular plug (blue arrow), peripheral in-focus telangiectasias extending to the central region
    (dotted arrow); white central follicular scar is also seen. (E) Telangiectasias are seen in all lesions corresponding
    to depressed scars in B, with a central white follicular scar. It is classically stellate, seen in lesion marked as an
    asterisk. (F) Linear yellowish region (asterisk) and multiple in-focus short linear and linear branching vessels
    along the lesion (black arrows).



2                                                                    Research Letter | Dermatol Pract Concept. 2022;12(1):e2022017
    Histopathologically, LMDF is characterized by follicular            post-kala-azar dermal leishmaniasis (Table 1). Papular sar-
plugs and a superficial dermal perifollicular granulomatous             coidosis shows orange-yellow structureless areas and does
infiltrate with or without caseation. Late lesions show exten-          not show follicular plugs and stellate scars. Granuloma-
sive perifollicular fibrosis.                                           tous rosacea shows vascular polygons not seen in LMDF.
    Dermoscopic features include follicular plugs, some re-                 Our case showed structureless yellow-orange regions,
sembling a target surrounding the center, with short linear             follicular plugs, and white structures as previously described
and linear-branching vessels on an orange-yellow/ erythem-              [2]. In addition to documenting these features in elongated
atous background. Different stages of lesions have different            plaques, we were able to see in-focus telangiectasias, both
dermoscopic features. With chronicity, there is an increase             in inflammatory lesions as well as in lesions evolving into
in follicular plugs and perifollicular scaling. The yellow              depressed scars. Some of these vessels were reaching the
perifollicular background is replaced by white structures in            center of the lesions. Earlier reports have noted unfocussed
late lesions, corresponding to fibrosis replacing the granu-            arborizing, comma-shaped and linear vessels. Yellow areas
lomas [1].                                                              and vascular changes were readily seen in our patient de-
    Dermoscopic findings of LMDF differ from other                      spite a darker skin phenotype. However, these observations
papular granulomatous facial disorders, such as papular                 are from one case and may be extrapolated if noted in more
sarcoidosis, granulomatous rosacea, lupus vulgaris, and                 patients.




Figure 2. Histopathological examination of facial papule showing features of lupus miliaris disseminates faciei. (A) Irregular acanthosis of
the epidermis and dermal perifollicular dense infiltrate with epithelioid cell granulomas (arrowhead) (H&E, ×100). (B) Higher magnifica-
tion; the infiltrate is composed of lymphocytes, epithelioid cells, and Langhans giant cells (arrow) (H&E, ×400).




               Table 1. Dermoscopy of Various Papular Granulomatous Disorders on the Face
                                Disorder                                                   Dermoscopic Findings
 Sarcoidosis                                                           Orange-yellow structureless areas with well-focused linear
                                                                       and branching vessels; white scar-like depigmented areas
 Granulomatous rosacea                                                 Linear reddish-violaceous vessels arranged in polygonal
                                                                       network with diffuse or localized orange areas
 Lupus vulgaris                                                        Yellowish-white globules, milia-like cysts, white
                                                                       structureless areas
                                                                       Pinkish red background, with telangiectasias (linear,
                                                                       branching)
                                                                       White scales, shiny white streaks, white rosettes
                                                                       A bluish hue may be seen
 Post-kala-azar dermal leishmaniasis                                   Multiple yellow tears and erythema
 Granuloma faciale                                                     Translucent white-gray background with whitish streaks
                                                                       and linear telangiectasia



Research Letter | Dermatol Pract Concept. 2022;12(1):e2022017                                                                             3
    Dermoscopic features of LMDF lesions vary with time          References
and can include in-focus telangiectasias in all stages of
                                                                 1. Litaiem N, Chamli A, Bacha T, et al. Dermoscopic features of
evolution, including early scars.
                                                                    lupus miliaris disseminates faciei: Distinct aspects depending on
                                                                    disease stage. Clin Case Rep. 2020;8(9):1793–1796. DOI: 10.1002/
Informed consent: Written informed consent for publica-             ccr3.2979. PMID: 32983497. PMCID: PMC7495779.
tion of clinical details and clinical images was obtained from   2. Chauhan P, Jindal R, Shirazi N. Dermoscopy of lupus miliaris
the patient.                                                        disseminatus faciei: a step closer to diagnosis. Dermatol Pract
                                                                    Concept. 2020;10(3):e2020055. DOI: 10.5826/dpc.1003a55.
                                                                    PMID: 32685274; PMCID: PMC7346596.




4                                                                   Research Letter | Dermatol Pract Concept. 2022;12(1):e2022017
