Cutaneous findings in systemic sarcoidosis

Diagnosis: Cutaneous findings in systemic sarcoidosis

Cutaneous findings in systemic sarcoidosis

Clinical Presentation

Cutaneous findings in systemic sarcoidosis

Clinical History

Red-brown papules, nodules, or plaques. Systemic workup: chest X-ray, pulmonary function, serum ACE, calcium, liver function. Biopsy showing non-caseating granulomas.

Treatment

Skin: topical/intralesional corticosteroids. Systemic: prednisone, methotrexate, hydroxychloroquine, TNF-alpha inhibitors. Treat based on organ involvement severity.

Differential Diagnosis

• Granuloma annulare • Foreign body granuloma • Lupus vulgaris (cutaneous TB) • Lymphoma • Rosacea • Leprosy • Tinea faciei

Key Learnings

• Non-caseating granulomatous disease of unknown etiology • Cutaneous involvement in ~25-35% of patients • Skin lesions: papules, nodules, plaques — classically red-brown to violaceous • Lupus pernio: violaceous plaques on nose, cheeks, ears — indicates chronic, severe disease • Erythema nodosum is the most common nonspecific cutaneous finding • Löfgren syndrome: bilateral hilar lymphadenopathy + erythema nodosum + polyarthralgias + fever (good prognosis) • Diascopy reveals "apple jelly" color — typical of granulomatous inflammation • Scar sarcoidosis: granulomas develop within old scars

Tags: case, cutaneous, dermatology, kodachrome, sarcoidosis