From drug therapy failures to laser therapy victory: A case report and literature review of lupus miliaris disseminatus faciei resolution.

Key Clinical Message: Pulsed dye laser (PDL) has proven effective in resolving lupus miliaris disseminatus faciei (LMDF) where drug therapies have failed with a lack of treatment consensus for LMDF, considering early PDL intervention is crucial to achieve resolution without scarring, prevent relapse, and enhance overall treatment outcomes. Abstract: Lupus miliaris disseminatus faciei (LMDF) is a rare inflammatory and granulomatous dermatologic disease that primarily affects the face. The optimal treatment for LMDF remains controversial, and there is a lack of consensus on the most effective therapy. This case report highlights the successful use of a 595 nm pulsed dye laser (PDL) in the treatment of LMDF following unsuccessful drug therapy. A 28-year-old male presented with reddish-brown eruptions on his face that had persisted for several months. Clinical examination revealed discrete dome-shaped eruptions in clusters on the central area of the face. Histopathological examination confirmed the diagnosis of LMDF, based on the presence of epithelioid granulomas with central caseous necrosis. Previous treatment with an oral isotretinoin and methotrexate combination also failed to yield satisfactory results. After discontinuing drug therapy, the patient underwent five sessions of PDL treatment. Ten days after the first session, the eruptions began to regress without scarring. Subsequent PDL sessions led to the complete resolution of the eruptions. The patient experienced no relapse during the follow-up period. This case report suggests that PDL treatment may be an effective option for LMDF, particularly in cases where drug therapy has failed. Early initiation of laser treatment may prevent scarring, minimize the adverse effects associated with drug therapy, and reduce the risk of disease relapse. Further research and controlled trials are needed to establish the efficacy of laser therapy in the treatment of LMDF.

Lupus Miliaris Disseminatus Faciei versus Granulomatous Rosacea: A Case Report.

Lupus miliaris disseminatus faciei (LMDF) and granulomatous rosacea are 2 distinct inflammatory dermatoses with overlapping clinical features: reddish-yellow papular eruptions localized on the central face. Consequently, LMDF can easily be misdiagnosed as granulomatous rosacea or vice versa. Because delayed treatment in LMDF may increase chances of permanent scar formation, accurate diagnosis is important. We therefore analyzed published literature and case studies to organize the essential features differentiating LMDF from granulomatous rosacea. In addition, we report each case of LMDF and granulomatous rosacea for direct comparison.

Self-limited acne agminate-like granulomatous reaction to facial laser rejuvenation in a patient with comedonal acne vulgaris.

Minimally invasive fractional rejuvenation was developed to overcome the drawbacks of the traditional ablative laser. The Fotona 4D laser is one of these lasers used for face lifting. This laser uses two wavelengths such as Nd-YAG 1064 and Er-YAG 2940 nm in four different modes of non-ablative and ablative fractional laser to induce bulk heating in different tissue layers of facial skin. Although the overall rate of fractional laser complications is much lower than that of traditional techniques, recent studies have shown that fractional lasers can cause complications such as acne, milia, prolonged erythema, infections, and pigmentary alterations.In this report, we present a very unique case of a 41-year-old female patient with mild comedonal acne who developed severe acne agminate-like granulomatous reaction following fractional rejuvenation laser therapy that resolved spontaneously within 2 months after laser therapy. To the best of our knowledge, this is the first case of acne agminate as a side effect of rejuvenation laser therapy.As ruptured hair follicles are proposed as a pathogenic factor in both acne agminate and developing acne following fractional laser therapies, it is recommended to cautiously use resurfacing fractional lasers or to thoroughly treat acne before laser therapy due to the risk of developing a granulomatous reaction.

A Case Report of Acne Agminata

Granulomatous facial skin lesions are a rare and challenging clinical problem. Differential diagnoses include cutaneous tuberculosis, sarcoidosis, granulomatous rosacea and acne agnimata. We reported a case of acne agminata presented with granulamatous facial papules.

Lupus miliar diseminado facial: presentación de un caso clínico y revisión de la literatura / Lupus miliar disseminated facial: Presentation of a clinical case and review of the literature

El lupus miliar diseminado facial es una enfermedad inflamatoria granulomatosa de etiología incierta, caracterizada por pápulas eritemato-amarillentas que afectan predominantemente la región facial. Luego de 1 a 4 años puede involucionar sin tratamiento pero dejando secuelas estéticas. Existen múltiples tratamientos con respuestas variables. Presentamos un caso con respuesta favorable al tratamiento con isotretinoína, sin recaídas a la fecha, y realizamos una revisión de la literatura (AU)

Lupus miliaris disseminatus faciei is a granulomatous inflammatory disease of unknown etiology, characterized by erythematous yellowish papules predominantly affecting facial region. After 1-4 years it may involute without treatment but leaving scarring sequelae. There are multiple treatments with variable responses. A case with favorable response to isotretinoin treatment, with no relapses to date, is reported and literature review is made (AU)