Beyond Acne: Unmasking a Varioliform Scar in an Adolescent Boy

A 16-year-old boy was diagnosed with Lupus miliaris disseminatus faciei (LMDF), an idiopathic granulomatous disorder affecting the central face, characterized by erythematous papules healing with varioliform scars. The condition, initially thought to be related to tuberculosis, is now considered an immune response to hair follicle destruction. The boy's lesions resolved with doxycycline treatment over 2 months. LMDF presents with symmetrical reddish-brown papules, primarily on the face, and can be mistaken for other granulomatous conditions. The exact cause remains unknown, but recent studies suggest a role for Cutibacterium acnes. Treatment options vary, with no standardized approach.