Search

Lupus miliaris disseminatus faciei or acne agminata is a chronic inflammatory disorder of the skin, considered an intriguing entity due to its pathogenesis, which is still largely speculative. It has been linked to tuberculosis, sarcoidosis, rosacea, and other granulomatous diseases, but it is considered an independent entity.

PURPOSE Acne agminata has only been rarely reported in the ocular adnexa. This study was undertaken to identify histopathological, clinical, and management features of this disorder. METHODS A computerized database was utilized to identify cases of ocular adnexal acne agminata. Via chart review and light microscopy, clinical and histopathologic aspects of this dermatosis were collected, and statistical analyses were performed. RESULTS Twelve cases (5 males, 7 females, mean age = 50.5 years) of clinically and histopathologically confirmed ocular adnexal acne agminata were identified. The main variant of granuloma was sarcoidal in 6 cases (50%) and tuberculoid in 5 cases (41.7%), although 9 specimens (75%) displayed greater than 1 variant of granuloma. In addition, specimens demonstrated varying degrees of fibrosis (8 cases, 66.7%), necrosis (6 cases, 50%), spongiosis (5 cases, 41.7%), and perifollicular inflammation (6 cases, 50%). All specimens showed signs of lymphstasis-lymphangiectasis. At a minimum of 6-month postprocedure interval, all patients experienced complete relief of their symptoms and did not experience recurrence. CONCLUSIONS This study represents the largest cohort of ocular adnexal acne agminata, and revealed a spectrum of granulomatous subtypes, including coexistence of different granuloma subtypes within the same specimen. Lymphangiectases is a hallmark of this disorder, and varying features of tissue reaction are typical features of acne agminata. All of these cases were successfully cured by surgical resection of lesions without recurrence at last follow-up, and this modality should be considered the standard of care in the management of this problem.

Lupus miliaris disseminatus faciei (LMDF) is an inflammatory dermatosis characterized by 1- to 3-mm red-to-yellow-brown papules on the central and lateral face, particularly on and around the eyelids. Lesions can occur singly or in crops. The discrete papules appear yellow-brown (“apple-jelly”) on diascopy and as epithelioid cell granulomas histologically, thus, resembling tuberculosis, sarcoidosis, or other granulomatous diseases.1 LMDF classically presents on the face; however, an increasing number of cases are reported with extrafacial involvement.1, 2, 3, 4, 5, 6 We describe a unique presentation of LMDF characterized predominantly by bilateral axillae involvement.

Acne agminata is a rare asymptomatic, inflammatory dermatosis, which affects adolescence and young adults, whose etiopathogenesis is already controversial. Clinically, acne agminata is characterized by red-yellow-brown papular-pustular eruption involving the central face, in particular cheeks, chin, forehead, and eyelids. The authors report a case of a 25-year-old Caucasian man affected by acne agminata treated with doxycycline and isoniazid.

A 45-year-old woman had a 1-year history of multiple small papules on both upper eyelids that waxed and waned in size and disappeared in the vicinity of a steroid injection site. Acne agminata (lupus miliaris disseminatus faciei, acnitis, papular tuberculid) is a rare form of necrotizing granulomatous inflammation of the dermis that has received scant attention in the ophthalmologic literature. The diagnosis is reached by excluding other forms of necrotizing granulomatous dermatitis based on clinical and histologic features.

Acne agminata (AA) and lupus miliaris disseminatus faciei (LMDF) have been used to describe very similar clinical conditions and it is now generally accepted that they are synonymous. The cause of these disorders has not been determined. Clinically the disease presents with often agminated redbrown to yellow papules which occasionally become pustular. Microscopically, superficial granulomatous inflammation with perifollicular caseating granulomas is the hallmark. Axillary involvement with LMDF has rarely been reported; in this area AA has been the preferred term. When only the axillae are affected, it may be difficult to distinguish acne agminata from other granulomatous diseases, especially from granulomas caused by antiperspirants containing aluminumzirconium complexes. We describe a 36-year-old woman with axillary acne agminata.

There has been a controversy as to the origin of lupus miliaris disseminatus faciei (LMDF). It was originally thought to be associated with tuberculosis, due to its histopathological similarity. Recently, this association has been doubted, although there remain reported cases of LMDF associated with Mycobacterium tuberculosis. Three patients with the clinical and histopathological features of LMDF are described. Skin from these patients was analysed by polymerase chain reaction (PCR) using two different oligoprimers for the detection of 123 bp and 165 bp DNA fragments specific for M. tuberculosis complex. With these two PCR systems, no M. tuberculosis DNA was detected in any of the LMDF patients. It was present in all positive controls and absent in all negative controls. In this study we could not demonstrate an association between LMDF and tuberculosis.

Lupus miliaris disseminatus faciei is a rare chronic, asymptomatic papular eruption, most commonly affecting the central face, including the eyelids. Our 2 patients presented with the typical clinical findings of small papular lesions in which histopathologic examinations disclosed granulomatous inflammation with necrosis associated with inflamed hair follicles. Except for its description as acne agminata by Duke-Elder in 1974, to the authors' knowledge, this condition has not been reported previously in the ophthalmic literature.

Granulomatous rosacea is a variant of rosacea characterized by hard cutaneous papules and nodules in relatively normal-appearing skin that is rarely diagnosed in childhood. The differential diagnosis essentially includes perioral dermatitis and sarcoidosis. Despite the differences in clinical presentation and histopathology, there is similar responses to the same therapies used in rosacea. Therapeutic failure should lead to the investigation of other rare and controversial conditions, such as acne agminata.

Acne agminata and lupus miliaris disseminatus faciei (LMDF) have been used to describe very similar clinical conditions and it is now generally accepted that they are synonymous.The cause of these disorders has not been determined. Clinically the disease presents with often agminated red-brown to yellow papules which occasionally become pustular. Microscopically, superficial granulomatous inflammation with perifollicular caseating granulomas with caseation are the hallmarks. Axillary involvement with LMDF has rarely been reported; in this area AA has been the preferred term. When only the axillae are affected, it may be difficult to distinguish acne agminata from other granulomatous diseases, especially from granulomas caused by antiperspirants containing aluminium-zirconium complexes. We describe a 36-year-old women with axillary acne agminata.

Sir, Lupus miliaris disseminatus faciei (LMDF) or acne agminata is a chronic inflammatory disorder that occurs singly or in crops on the eyelids, cheeks and nasolabial folds (1). Clinically it consists of multiple indolent bright-red or brown papules. Histologically, it is characterized by dermal masses of tuberculoid granulomas with central caseation necrosis. LMDF is currently widely considered as a variant of rosacea (2). However, in contrast to rosacea, which shows a chronic course, LMDF runs a self-limiting course with spontaneous resolution of the lesions during 12–24 months, often leaving disfiguring scars. The occurrence of LMDF appears to be related to an immune response to the pilosebaceous units (3), suggesting that immunosuppressants would be good candidates for therapy. We describe here a patient with LMDF who was treated successfully with intramuscularly administered triamcinolone acetonide.

The name acne agminata was applied by Crocker 1 to a rare acne-like eruption, usually limited to the face. A characteristic feature was a tendency for the lesion to group about the chin, the cheeks, the forehead, the upper lip and the eyelids. Crocker stated that Perry and he had each shown two cases, and Galloway one case, before the London Dermatological Society (date not given). He described the individual lesions as varying in size from that of a pinhead to that of a milletseed, occasionally a little larger. They were mostly a dull brownish red, but some had a yellow central point with or without a comedo. The majority, however, were not connected with the sebaceous glands. They appeared to be solid but many exuded pus when pressed on. In some instances two or three had coalesced into an oblong nodular patch, producing a lupoid aspect. In general appearance