Case Number : Case 2793- 22 March 2021 Posted By: Richard Logan

A form of rosacea

caseating granuloma also seen in Lupus miliaris D facei-a form of rosacea

Rosacea. 

12 hours ago, Krishnakumar subramanian said:

A form of rosacea

caseating granuloma also seen in Lupus miliaris D facei-a form of rosacea

Agree

Lupus Miliaris Disseminatus Faciei.

Could be a form of Rosacea but also could be a tuberculide (epidemiology is important)

Rosacea or LMDF are my differential too. 

My differentials include LMDF and tuberculosis, but i would favor the former.

Granulomatous Rosacea vs. LMDF

LMDF.

Yes, this is acne agminata (lupus miliaris disseminatus faciei).

I posted this case because there hasn't been an example of this rare condition on the website before.  The slides have suffered from being scanned from old photomicrographs and are over-exposed.  Nevertheless, you can still appreciate the interfollicular position of the dermal granulomata and the characteristic caseating necrosis, which is not directly or indirectly due to Mycobacteria.

As might be inferred from the histopathology, the clinical lesions in this condition are numerous, small, red-brown papules on the face and eyelids.  There are good images of it on the DermnetNZ site.  Although perhaps related to a granulomatous form of rosacea, these patients don't usually show the other, vascular features of rosacea.