Immune profiling of lupus miliaris disseminatus faciei and successful management with anti-TNF therapy.

Lupus miliaris disseminatus faciei (LMDF) is a chronic inflammatory dermatosis of unknown etiology, most often seen in young adults. Although many treatment modalities exist for LMDF, treatment guidelines have not been developed and response to therapy is generally unpredictable. Herein, we present transcriptomic analysis of LMDF lesional skin, which revealed a variety of differentially expressed genes linking LMDF to alterations in innate and adaptive Th1 immunity. Immunohistochemical analysis was also performed, identifying similar changes in T cell immune responses. Given evidence for increased TNF pathway activity, our patient, who had previously been refractory to multiple treatment modalities, was initiated on tumor necrosis factor inhibitor (TNFi) therapy with excellent response. This characterization of the LMDF immune response may lead to improved treatment of this condition.