Sarcoidosis is an autoimmune disease in which clumps of immune cells, called granulomas, form in different tissues and organs. These clumps can lead to scarring and interfere with how well an affected organ works.

What is cutaneous sarcoidosis?

In cutaneous sarcoidosis, granulomas form in the skin, although some types of skin lesions can form without granulomas.

Skin manifestations of sarcoidosis are estimated to occur in approximately 25 percent of patients. Approximately one-third of patients with cutaneous sarcoidosis have no other organ involvement.

Cutaneous sarcoidosis is often spontaneous and poses no threats to general health. Full recovery is seen in many cases. However, for some patients, skin lesions may be painful and may result in the skin becoming damaged or scarred.

Symptoms of cutaneous sarcoidosis

Cutaneous sarcoidosis can be divided into two groups based on a skin biopsy: disease-specific or granuloma-containing lesions, and nonspecific or non-granuloma containing lesions. When disease-specific, cutaneous sarcoidosis is divided into three different types based on the location and appearance of the bumps or lesions. They are known as erythema nodosum, lupus pernio, and plaque-like lesions.

Erythema nodosum is characterized by the sudden appearance of tender bumps, about 1 to 2 cm in diameter, mostly on the shins. It is often accompanied by arthritis in the ankles, elbows, wrists, and hands. Oher symptoms of erythema nodosum include fever, fatigue, and joint pain. Eighty percent of patients usually see lesions heal completely within six months. Erythema nodosum is a common sarcoidosis-related skin condition and usually found in acute forms of this disease.

Lupus pernio is characterized by large and painful, bluish-red or dusky purple bumps on the nose, cheeks, ears, fingers, and toes that can lead to scarring. These lesions indicate a chronic condition, and treatment is important.

Plaque-like lesions appear as purple-red or brown, thickened and circular areas of skin. A biopsy of these lesions will show granulomas, and patients with plaque-like lesions usually have systemic involvement.

Diagnosis of cutaneous sarcoidosis

Cutaneous sarcoidosis is generally diagnosed through a skin biopsy.

Chest x-rays and lung biopsies may also be performed to confirm a diagnosis of sarcoidosis, because cutaneous sarcoidosis usually accompanies granuloma formation in other organs and most commonly the lungs. Sarcoidosis can also affect the kidneys, and tests of kidney function may also be requested.

Treatment of cutaneous sarcoidosis

Typically, cutaneous sarcoidosis is first treated with topical corticosteroids creams. Corticosteroid tablets such as prednisone may also be prescribed in more severe cases.

Immunosuppressant treatments, such as methotrexate or azathioprine, may be prescribed if cutaneous sarcoidosis does not respond to corticosteroids. Hydroxychloroquine, commonly used to treat malaria, can also be prescribed to treat cutaneous sarcoidosis.

Laser surgery has been used in treating disfiguring skin plaques and lupus pernio. Much like laser tattoo removal, a laser is briefly fired at the lesion, breaking up the fibrotic tissue and granulomas so as to allow the immune system to clear and repair the lesion.

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