| disease | Lupus Miliaris Disseminatus Faciei |
| alias | Miliary Lupus-like Tuberculosis, Upus Miliaris Faciei, Facial Disseminated Miliary Tuberculosis, Facial Disseminated Miliary Lupus, Follicular Miliary Lupus |
Facial foxtail millet-like lupus (Lupus Miliaris Faciei), also known as disseminated facial foxtail millet-like lupus (lupus miliaris disseminatus faciei), follicular foxtail millet-like lupus (lupus miliaris follicularis), foxtail millet-like lupus subcutaneous nodule disease (tuberculosis lupusa miliaris), or disseminated facial foxtail millet-like subcutaneous nodule disease (tuberculosis miliaris disseminata faciei). It presents as scattered, round, non-ulcerating papules on the face, which leave atrophic scars after healing.
bubble_chart Etiology
It was previously believed that this disease was a hematogenously disseminated cutaneous subcutaneous node, a variant of lupus vulgaris or a subcutaneous node rash. Although the histological changes are typical of a subcutaneous node structure, the general health of the patients is good, and most patients do not exhibit other subcutaneous nodes. Subcutaneous node bacilli cannot be found in the lesions. The subcutaneous node bacillus test is often negative, and anti-subcutaneous node treatment is mostly ineffective. Therefore, it is considered that this disease is unrelated to subcutaneous nodes.
In recent years, some have suggested that this disease is a special type of papular rosacea. Some scholars have found abnormalities in cellular immunity in patients with this condition.
bubble_chart Pathological Changes
The epidermis shows vacuolar degeneration of prickle cells and increased pigmentation in the basal cells. The middle and lower dermis exhibit typical subcutaneous nodular structures, surrounded by epithelioid cells and giant cells, with central caseous necrosis. Within the infiltrates, collagen and elastic fibers show degeneration or disappearance, and thrombosis and vascular occlusion are observed in the blood vessels.
This disease commonly occurs on the face of adults, particularly around the eyelids, nose, mouth, and cheeks. In a few cases, skin lesions may appear symmetrically on the ears, neck, shoulder blades, and limbs. The lesions are round papules or nodules, 2–3 cm in diameter, pale red or reddish-brown, and semi-transparent. When pressed with a glass slide, they exhibit an apple-jelly color. The surface of the nodules is smooth, and some may have pinpoint-sized pustules at the top or form fish-scale-like crusts.
The nodules appear in batches, varying in number from a few dozen to hundreds, scattered independently. Adjacent nodules, two or three at a time, may merge together. Particularly on the lower eyelids, multiple nodules often fuse to form a ridge-like structure. There are no subjective symptoms.
The course of the disease is chronic. Over months or years, the nodules gradually resolve, leaving behind atrophic scars of the same size as the original nodules.
The diagnosis can be made based on the symmetrical occurrence of red nodules on the face, which appear apple-jelly colored when pressed with a glass slide. The nodules subside, leaving atrophic depressed scars without any subjective symptoms, and the combination of pathological changes.
bubble_chart Treatment Measures
Some cases of this disease may resolve spontaneously. Oral corticosteroids can alleviate symptoms. Anti-subcutaneous node medications, such as isoniazid and streptomycin, are generally ineffective.
1. Rosacea In addition to papules on the face, there are capillary dilating erythema on the nasal tip and cheeks. The follicular openings are often enlarged. In the advanced stage, rhinophyma forms, often accompanied by seborrhea.
3. Papulonecrotic subcutaneous nodular rash Skin lesions occur not only on the face but also on the limbs and trunk, presenting as symmetrical necrotic papules.
4. Sebaceous adenoma Scattered yellowish capillary-dilating papules or nodules appear in the central area of the face, with no subjective symptoms. It is often accompanied by intellectual disability and epilepsy.
