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In this section we have spot diagnoses posted on a daily basis since June 2010, now over 1700! You can review the archived cases and read the suggested diagnoses by users and the final comment by Dr Uma Sundram, the Editor-in-Chief and main spot diagnosis host. Case are uploaded each week day by 10 a.m. UK time with the correct diagnosis will generally be posted at 8 p.m. UK time. Why not view the most recent spot diagnosis and proffer a diagnosis?

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

Please read the clinical history and view the images by clicking on them before you proffer your diagnosis.
Submitted Date :
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M 34 biopsy from face


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Krishnakumar subramanian

Posted

A form of rosacea

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

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vincenzo

Posted

Rosacea. 

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Josie Bisi

Posted

12 hours ago, Krishnakumar subramanian said:

A form of rosacea

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

Agree

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Alex-Ventura-Leon

Posted

Lupus Miliaris Disseminatus Faciei.

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

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Meenakshi Batrani

Posted

Rosacea or LMDF are my differential too. 

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Carmen Lisievici

Posted

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

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Victor Delgado

Posted

Granulomatous Rosacea vs. LMDF

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Eman El-Nabarawy

Posted

LMDF.

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Richard Logan

Posted

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.

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