Lupus miliaris disseminatus faciei-pathologic study of early, fully developed, and late lesions

Lupus miliaris disseminatus faciei is a chronic inflammatory disorder, which affects adults of both sexes. This study included 25 patients with lupus miliaris disseminatus faciei. Three biopsies, representing early, fully developed, and late lesions, were taken from each patient. Histopathologic examination of the different lesions revealed that in early lesions, all of them showed superficial perivascular and periappendigeal cellular infiltrate composed mostly of lymphocytes and few histiocytes with occasional neutrophils. The fully developed lesions showed a sarcoidal granuloma only (40%), sarcoidal granuloma with abscess (24%), sarcoidal granuloma around areas of caseation necrosis (20%), and a mixture of sarcoidal and tuberculoid granulomas (16%). All the late lesions showed extensive fibrosis especially in the perifollicular areas. Scattered lymphocytes, histiocytes and neutrophils were present within the fibrotic areas. A possible explanation of the pathogenesis is discussed.