Lupus Miliaris Disseminatus Faciei: A Venture into the Uncommon-Four Cases of Acne Mimicking Facial Dermatopathy – A Case Series

Lupus miliaris disseminatus faciei (LMDF) is a rare chronic granulomatous skin disorder primarily affecting the face, often misdiagnosed due to its resemblance to acne, rosacea or other granulomatous diseases. It predominantly presents as erythematous papules or nodules, commonly involving the periorbital region, nasolabial folds, lower jaw, forehead and cheeks. LMDF follows a persistent course with episodic flare-ups, frequently resulting in atrophic scarring. The pathogenesis likely involves a dysregulated immune response to pilosebaceous materials, with a possible hypersensitivity reaction to Mycobacterium tuberculosis . Histopathology varies by stage, showing epithelioid granulomas with or without necrosis. Dermoscopy reveals characteristic orange-yellow backgrounds with follicular plugging. Treatment remains challenging, involving corticosteroids, isotretinoin, antibiotics, immunosuppressants and laser therapy. Early intervention is crucial to prevent chronicity and scarring. Here, we discuss four cases evaluated in our dermatology outpatient department, highlighting clinical features, diagnostic challenges and therapeutic outcomes.