Lupus miliaris disseminatus faciei (LMDF) is an non-infective granulomatous skin disease characterized by asymptomatic monomorphic smooth papules on the central face. It classically involves the lower eyelid, in conjunction with perifollicular granulomas on histology and can cause scarring. So early treatment isa key to reduce scarring. Tetracycline, isotretinoin, oral corticosteroids and dapsone have been found to be variably effective. Recently an article showing efficacy of ruxolitinib, a selective Janus kinase (JAK)–1/2 inhibitor in LMDF was published in JAMA Dermatology.
A 46-year-old otherwise healthy woman presented with numerous monomorphic, mildly erythematous, and skin-colored 1-mm to 2-mm smooth indurated papules on the face since 2-years which was gradually progressing. The papules coalesced into plaques that involved the upper and lower eyelids, forehead,medial cheeks, cutaneous lips, and chin. Punch biopsy from the lesion showed perifollicular noncaseating granulomas with multinucleated giant cells without a substantial lymphoid infiltrate. Acid-fast stain results for mycobacteria and periodic acid-
Schiff stain results for fungus were negative. Lab investigations were done to rule out sarcoidosis and tuberculosis. The histopathology findings with marked eyelid involvement led to a diagnosis of LMDF.
A 2-month treatment course of ivermectin, 1%, cream once daily and doxycycline, 100 mg, twice daily provided no improvement. Then treatment with ruxolitinib, 1.5%, cream twice daily was administered to affected areas. After 1-month, a 75%reduction in facial papules was observed. Patient continued to have improvement at follow up visit of 3 months. No adverse events were reported. Increasing evidence is showing that JAK inhibition may play a role in treating granulomatous skin conditions. Successful use of oral and topical JAK inhibitors for cutaneous sarcoidosis, granuloma annulare has been reported. Consistent with this emerging literature, the present case suggests that topical JAK inhibition may be particularly effective in treating certain cases of LMDF.
The authors found fast and good response to ruxolitinib, 1.5%, cream in LMDF without adverse effects. Thus ruxolitinib may be a safe and effective alternative to systemic agents in certain cases of LMDF.
Source- Gorham NC, Jacobs J, Wu SZ. Response of Severe Lupus Miliaris Disseminatus Faciei to Treatment With Ruxolitinib Cream. JAMA Dermatol. 2023 Apr 26. doi: 10.1001/jamadermatol.2023.0528. Epub ahead of print. PMID: 37099285.
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