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

Abstract

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.

Keywords: LMDF; acne agminata; granulomatous dermatosis; lupus miliaris disseminatus faciei; pulsed dye laser.

FIGURE 1

(A and B) discrete dome‐shaped maculopapular eruptions are visible within around lower palpebrae and adjacent to nose. (C and D) Few days After first session of laser treatment, eruptions began to regress without scarring. Scars prior to laser treatment still remained.

FIGURE 2

Histopathologic examination revealed Langhans giant cells, or possibly epithelioid and multinucleated giant cell infiltration, along with central caseous necrosis. (A) ×40, (B) ×100.

FIGURE 3

The patient's treatment timeline, indicating the difference between the satisfactory treatment after laser treatment in contrast with the drug therapy.