How would you treat this woman’s acne-like eyelid eruption?

A 53-year-old female presented after a few weeks of acne-like eruption on her eyelids that were slightly tender at touch. She is otherwise healthy and denies any new exposure history.

How would you diagnose this eyelid eruption?

A. Acne
B. Rosacea
C. Lupus miliaris disseminatus faciei 
D. Sarcoidosis
E. Syringomas 

(Answer and discussion on next page)

Answer: Lupus miliaris disseminatus faciei

Lupus miliaris disseminatus faciei is an uncommon condition that commonly affects the eyelids and can spread onto the face. Lesions can last 1 to 2 years before spontaneously resolving. The etiology is unknown. Most patients respond to tetracycline class antibiotics and/or low-dose systemic steroids.

Acne and rosacea are often confused though these lesions tend to persist much longer that acne or rosacea lesions. Sarcoid can certainly mimic these lesions; therefore, a biopsy is often helpful. Syringomas are usually not erythematous or as inflamed.