[Facial granulomatous dermatoses].

not merely blemishes on the skin: A study on the morbidity associated with having viral cutaneous warts. Dermatosis granulomatosas faciales To t he Edit or: The term f acial granulomat ous dermat osis refers t o a group of disorders characterized by facial papules with the common histological feature of epithelioid granulomas. We present a patient whose condition fitted this classification both clinically and histologically, and who illustrates well the difficulties experienced when managing this disorder. The patient was a 64-year-old woman with no family or personal past history of interest. She was seen in 2005 for asymptomatic facial lesions. On physical examination she presented erythematous papules of 1 mm in diameter in the perioral region, with no comedones or pustules (Figure 1). The initial suspicion was of perioral dermatitis and treatment was started with oral doxycycline (100 mg/12 h) for 3 months, with no improvement. A biopsy Figure 1 Patient with perioral erythematous papules and pustules. There are no comedones. was therefore performed; in areas close to the hair follicles there were multiple granulomatous structures formed of epithelioid cells with a peripheral lymphocytic infiltrate and central necrosis, compatible with lupus miliaris disseminatus faciei (LMDF). Ziehl-Neelsen stain performed on the histological specimen was negative for acid and alkali-fast bacilli (Figure 2). Further additional tests, including complete blood count, erythrocyte sedimentation rate, biochemistry, calcium, Mantoux, chest radiograph, and angiotensin-converting enzyme levels, were normal or negative. The patient was then administered oral prednisone, with a response only at doses higher than 20 mg/d. She did not tolerate minocycline, sulfone, or thalidomide, and, after oral isotretinoin, developed an intense outbreak of lesions that extended to the periocular and malar regions (Figure 3). Over time, the outbreaks have affected the periocular region, cheeks, and neck, and, in the last year, have been associated with episodes of facial flushing. Some lesions have left pinpoint scars. Documento descargado de http://www.actasdermo.org el 07/04/2017. Copia para uso personal, se prohíbe la transmisión de este documento por cualquier medio o formato.