Issue link: http://viewer.e-digitaledition.com/i/917721
Diagnosis: Lupus miliaris disseminatus faciei (LMDF) Pathologic report (prepared by Erick Jacobson, MD, board- certified dermatopathologist): Histologic sections demonstrate a punch biopsy of skin with a relatively unremarkable overlying epidermis. Within the superficia l dermis is a perifollicular chronic granulomatous inflammatory infiltrate with a focus of necrobiosis. Suppor tive infla mmation is absent. Deeper sections were performed and reviewed. PAS and Gram stains are negative for microorganisms. Polarization is negative for birefringent materia l. The findings are most compatible with the clinical impression of lupus miliaris disseminatus faciei, a rare papular eruption that occurs on the face. It has a lso been ca lled acne agminata, acnitis, facial idiopathic granulomas with regressive evolution (FIGURE). In the past, LMDF was believed to be a subtype of cutaneous tuberculosis. That is no longer believed to be true. Additionally, some believe the condition to be a variant of granulomatous rosacea or sarcoidosis. Most commonly, LMDF is now believed to be a distinct entity. LMDF affects adolescents and adults, both men and women. LMDF usua lly resolves on its own in one to three yea rs with notable pitted sca rring. Unfor tunately, no one wa nts bumps on their face for one to three yea rs that turns onto pit ted sca rs, so in my practice I have had ver y satisfactor y results using ora l a ntibiotics, isotretinoin, a nd both topica l a nd ora l dapsone. Topica l steroids had been rema rkably ineffective in my experience. For more information, contact Charles E. Crutchfield III, MD, at Crutchfield Dermatology or visit CrutchfieldDermatology.com. n Results That Deliver Chronic Back and Neck Care That Works • 98% patient satisfaction • 150% increase in Lumbar range of motion & strength • 123% increase in Cervical range of motion & strength • 73% of patients rate their headache reduction between 50-100% • 73% of patients rate their use of medications decreased 50-100% ...Without Surgery, Injections or Drugs 5 Convenient Twin Cities Locations Edina 952-908-2700 Chanhassen 952-908-2730 Burnsville 952-908-2710 Coon Rapids 952-908-2580 Maplewood 952-908-2727 www.PDRclinics.com A 30-YE AR-OLD WOMAN PRESENTS WITH A SIX-MONTH PAPUL AR R A SH AROUND THE MOUTH. TOPICAL ANTIBIOTICS AND TOPICAL STEROIDS HAVE BEEN OF LIT TLE HELP. Case of the Month with Crutchfield Dermatology 1 8❱❱❱❱❱ D I A G N O S T I C S 1 8