Authors' reply.

Sir,

This is with reference to your letter commenting on the case report titled ‘Cutaneous sarcoidosis — A great masquerader: A report of three interesting cases,’ for case 1 and case 3. We appreciate the suggestion of considering Acne agminata or lupus miliaris disseminatus faciei (LMDF), both clinically and histpathologically, but the reasons to omit this are as follows:

It differs clinically, because the lesions are smooth dome-shaped papules without any necrotic center and there were no scars, either superficial or deep, suggestive of the healed lesions of LMDF, as the lesions of LMDF last for months and heal with scarring.[1]

Lupus miliaris disseminatus faciei is considered as one of the invisible dermatoses, for which the diagnosis is mainly histopathological. We were waiting for the histopathology report to consider the same on arrival of the histopathology diagnosis, but for the fact that the granulomas were clearly and distinctively naked epitheloid granulomas and there was no necrosis or caseation; also the pathologist had performed the Reticulin stain as per our suggestion at the time of request and that was in favor of sarcoidosis. As you have rightly pointed out, sarcoidal granulomas could be the first stage of histological presentation of LMDF.[2] We would like to inform you that the lesion biopsied was nearly one year old, by which time probably if it were to be LMDF, it would have developed necrosis at least histologically.

Also, the elevated serum Angiotensin converting enzyme level was a contributory finding for the diagnosis of sarcoidosis.

By this we conclude by stating that at all levels, clinical, investigative, histopathological, and special stain, the diagnosis was very close to sarcoidisis, and we could not find good supportive points for the diagnosis of LMDF.

We deeply appreciate your communication.