Case Report: Lupus miliaris disseminatus faciei successfully treated with thalidomide combined with photodynamic therapy: two cases and literature review

TL;DR

Two young men with a rare facial skin condition called LMDF were successfully treated with a combination of thalidomide and photodynamic therapy, leading to significant improvement and minimal scarring.

Contribution

This case report presents a novel combination therapy of thalidomide and photodynamic therapy for refractory LMDF.

Findings

Combination therapy with thalidomide and 5-aminolevulinic acid-based PDT led to marked resolution of LMDF lesions.

Minimal depressed scars remained after treatment, with no relapse observed during 24-month follow-up.

The therapy suggests a potential effective option for treating refractory LMDF cases.

Abstract

Lupus miliaris disseminatus faciei (LMDF) is a rare granulomatous rosacea characterized by multiple papular eruptions primarily affecting the central face, resulting in both physical discomfort and notable cosmetic concerns. Despite various proposed therapies, the optimal treatment for LMDF remains controversial. Photodynamic therapy (PDT) employs a photosensitizer, light source, and oxygen to generate reactive oxygen species (ROS) that selectively target and destroy abnormal tissue, and it has also been shown to reduce and prevent scar formation. However, data on PDT use in LMDF is limited. Here, we report two young male patients with LMDF presenting with multiple firm red papules on the face, both of whom had previously received four lines of treatment—including antibiotics (minocycline, doxycycline, clarithromycin), topical tacrolimus, and traditional Chinese medicine—without clinical improvement. Both patients subsequently underwent four sessions of 5-aminolevulinic acid-based PDT (5-ALA-PDT) combined with oral thalidomide. Following this combination therapy, the lesions showed marked resolution, leaving only minimal depressed scars, and no relapse occurred during a 24-month follow-up. These cases suggest that PDT combined with thalidomide may provide an effective option for refractory LMDF, with early intervention potentially minimizing scarring. Further studies and controlled trials are warranted to confirm the efficacy and safety of this therapeutic approach.

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