Microblading among sarcoidosis triggers, per case report study

Esthetic technique deemed cause of cases in two women

Patricia Inácio, PhD avatar

by Patricia Inácio, PhD |

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Microblading, a cosmetic technique that employs fine needles to deposit pigment to mimic the appearance of hairs, may be among triggers for sarcoidosis, according to a study.

“When esthetic procedures become increasingly popular, patients with chronic lesions at the injection site of the foreign material, especially macular, papular, or nodular lesions of orange-red color, should be appropriately evaluated for possible sarcoidosis,” the researchers wrote in the study, “Microblading reaction as a manifestation of systemic sarcoidosis: two case reports and a review of the literature,” published in the Journal of Medical Case Reports.

Systemic sarcoidosis is characterized by the development of granulomas — clusters of inflammatory cells — that occur concurrently in multiple organs throughout the body. While the disease’s exact cause is unknown, genetic predisposition and certain infections are known disease triggers.

Growing evidence suggests that certain esthetic procedures that involve skin infiltration may serve as triggers for sarcoidosis in predisposed people.

Researchers at the University of Ljubljana, Slovenia, described in the study the cases of two women who developed systemic sarcoidosis after undergoing microblading procedures. Microblading is mostly used on the eyebrows, but has also gained popularity among patients with hair loss (alopecia) due to chemotherapy or a low reactive thyroid.

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Orange-red plaques in eyebrow area

In one case, a 33-year-old woman developed plaques with an orange-red hue in the eyebrow area. The plaques appeared within one year after a single session of microblading.

After excluding contact dermatitis, an itchy rash caused by direct contact with a substance or an allergic reaction to it, as a cause, doctors suspected the lesions were sarcoid granulomas. The patient’s family history and personal history were “unremarkable,” with the exception of a breast-enlargement procedure two years before the skin lesions appeared, the researchers wrote.

A biopsy of one of the skin lesions revealed sarcoid granulomas, and the patient was referred for blood tests and a chest X-ray.

While the patient’s blood work was normal, the X-rays confirmed she had lung lesions consistent with sarcoidosis. She didn’t report any lung symptoms, but a lung specialist confirmed she had pulmonary sarcoidosis with early signs of scarring (fibrosis).

The patient started daily treatment with a 16 mg dose of prednisolone, a corticosteroid, which was administered intravenously (into the vein). She was also treated with mometasone cream, also a corticosteroid, twice weekly.

After three months, no skin lesions were visible. There were no recurrences during a two-year follow-up, despite the prednisolone dose being tapered to 6 mg every other day. Lung lesions also disappeared.

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Second case involves similar lesions

The second case was similar. It also concerned a 33-year-old woman, who had been undergoing microblading for six years. She developed orange-red plaques in the eyebrow area that had been present for three months, but no other skin lesions were observed.

Her family history was negative for sarcoidosis, and her personal history was uneventful. Again, the skin lesions’ color led clinicians to suspect sarcoidosis granulomas, which were confirmed following a biopsy.

Blood tests revealed elevated levels of the angiotensin-converting enzyme and chitotriosidase — common sarcoidosis biomarkers — as well as generalized markers of inflammation.

A chest X-ray showed the patient also had lung involvement. A pulmonologist confirmed it as a case of sarcoidosis. However, since there were no signs of progressive disease, no treatment was performed. Further exams revealed no involvement of additional organs.

A high-resolution CT scan conducted six months after the diagnosis revealed that the lesions in the lungs naturally resolved.

For her skin lesions, the patient was treated with mometasone cream once daily for 10 days and then twice weekly as maintenance, but with no immediate results. Easing of the skin lesions was noticeable after one year; however, a slight reddish hue was still present in the eyebrows.

“As our two cases also demonstrated, dermal or subcutaneous infiltration with foreign material during esthetic procedures can trigger the manifestation of sarcoidosis,” the researchers wrote.