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Case ReportsAbstract
Disseminated lupus miliaris, also known as acne agminata, is an uncommon chronic granulomatous dermatosis that typically affects adolescents and young adults. Clinically, it presents as erythematous to yellowish dome-shaped papules predominantly in the centrofacial area. We present the case of a 63-year-old female with an 8-month history of progressive erythematous papules on the lower eyelids and chin, initially diagnosed as dermatitis. The patient was treated with metronidazole and doxycycline for 10 days, but discontinued therapy due to worsening lesions. Given the lack of clinical improvement, a skin biopsy was performed. Histopathology revealed granulomatous inflammation in the dermis with palisading histiocytes surrounding areas of collagen degeneration with a necrobiotic calcified pattern. Multinucleated giant cells of Langhans and foreign-body type were also observed. These findings were consistent with disseminated lupus miliaris. This diagnosis is rarely considered in elderly patients, highlighting the importance of including it in the differential diagnosis of granulomatous dermatoses regardless of age. Although the exact etiology remains unclear, the most accepted theory involves follicular rupture leading to antigen exposure and granuloma formation. Histologically, well-formed granulomas around disrupted follicular units are characteristic. The clinical differential diagnosis includes perioral dermatitis, granulomatous rosacea, sarcoidosis, cutaneous tuberculosis, and other infectious or inflammatory granulomatous conditions. Treatment is not standardized; reported options include doxycycline, systemic corticosteroids, dapsone, isotretinoin, and clofazimine. This case emphasizes the need for histopathological confirmation in persistent dermatoses and supports awareness of this rare entity in atypical age groups to ensure accurate diagnosis and optimal management.