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Cedirian S, Comellini V, Chessa MA, Ravaioli GM, Misciali C, Nava S, LA Placa M. Subcutaneous sarcoidosis: a case series from a single center. Ital J Dermatol Venerol 2024; 159:344-348. [PMID: 38808460 DOI: 10.23736/s2784-8671.24.07711-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2024]
Abstract
BACKGROUND Sarcoidosis is a multisystemic granulomatous disease which not only affect the skin but can also involve the lymph nodes, eyes, and lungs. Subcutaneous sarcoidosis (SCS), is a rare form of sarcoidosis which is generally more prevalent in women in their 40s and 50s, characterized by subcutaneous, flesh-colored nodules, mostly localized on the limbs. A retrospective study to investigate clinical features and response to treatment in patients affected by SCS. METHODS All patients with systemic and/or cutaneous sarcoidosis visited in our clinic hospital between 2012 and 2022. Out of this group, clinical features, and management of SCS patients were analyzed. RESULTS Out of 102 patients with specific lesions of cutaneous sarcoidosis, with or without systemic involvement, 13 (13%) were diagnosed with SCS. CONCLUSIONS Our study confirms that systemic involvement in SCS is the prevalent finding as expected. Moreover, SCS patients have a relatively good prognosis, and systemic treatment does not differ from first-line therapies for cutaneous sarcoidosis.
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Affiliation(s)
- Stephano Cedirian
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Vittoria Comellini
- Unit of Respiratory and Critical Care Unit, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Marco A Chessa
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giulia M Ravaioli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Cosimo Misciali
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Stefano Nava
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Unit of Respiratory and Critical Care Unit, IRCCS University Hospital of Bologna, Bologna, Italy
| | - Michelangelo LA Placa
- Unit of Dermatology, IRCCS University Hospital of Bologna, Bologna, Italy -
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Mahajan A, Mousa A, Aslam F. Ultrasound in diagnosis of cutaneous sarcoidosis. Joint Bone Spine 2024; 91:105667. [PMID: 38043679 DOI: 10.1016/j.jbspin.2023.105667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/23/2023] [Indexed: 12/05/2023]
Affiliation(s)
| | | | - Fawad Aslam
- Mayo Clinic in Arizona, Scottsdale, AZ, USA.
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3
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Sillanmäki S, Iso-Mustajärvi S. 18F-FDG-PET of cardiac sarcoidosis with subcutaneous nodules. J Nucl Cardiol 2023; 30:2839-2840. [PMID: 37253988 PMCID: PMC10229220 DOI: 10.1007/s12350-023-03302-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 06/01/2023]
Affiliation(s)
- Saara Sillanmäki
- Diagnostic Imaging Center, Kuopio University Hospital, P.O. Box 100, 70029, Kuopio, Finland.
- University of Eastern Finland, Kuopio, Finland.
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4
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Ezeh N, Caplan A, Rosenbach M, Imadojemu S. Cutaneous Sarcoidosis. Dermatol Clin 2023; 41:455-470. [DOI: 10.1016/j.det.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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5
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Chamli A, Massaoudi C, Frioui R, Ben Brahim E, Debbiche A, Fenniche S, Hammami H, Zaouak A. A tale of subcutaneous nodules of the hands. Scand J Rheumatol 2022:1-2. [DOI: 10.1080/03009742.2022.2152586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- A Chamli
- Dermatology Department, Research Unit ‘Genodermatoses and Cancers LR12SP03’, Habib Thameur Hospital, Tunis, Tunisia
| | - C Massaoudi
- Dermatology Department, Research Unit ‘Genodermatoses and Cancers LR12SP03’, Habib Thameur Hospital, Tunis, Tunisia
| | - R Frioui
- Dermatology Department, Research Unit ‘Genodermatoses and Cancers LR12SP03’, Habib Thameur Hospital, Tunis, Tunisia
| | - E Ben Brahim
- Anathomopathology Department, Research Unit ‘Genodermatoses and Cancers LR12SP03’, Habib Thameur Hospital, Tunis, Tunisia
| | - A Debbiche
- Anathomopathology Department, Research Unit ‘Genodermatoses and Cancers LR12SP03’, Habib Thameur Hospital, Tunis, Tunisia
| | - S Fenniche
- Dermatology Department, Research Unit ‘Genodermatoses and Cancers LR12SP03’, Habib Thameur Hospital, Tunis, Tunisia
| | - H Hammami
- Dermatology Department, Research Unit ‘Genodermatoses and Cancers LR12SP03’, Habib Thameur Hospital, Tunis, Tunisia
| | - A Zaouak
- Dermatology Department, Research Unit ‘Genodermatoses and Cancers LR12SP03’, Habib Thameur Hospital, Tunis, Tunisia
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6
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Systemic sarcoidosis with subcutaneous, muscular, cardiac, and lymph node involvement. Clin Rheumatol 2022; 41:2913-2914. [PMID: 35608732 DOI: 10.1007/s10067-022-06222-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/03/2022]
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7
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Youn P, Francis RJ, Preston H, Lake F. Subcutaneous sarcoidosis (
Darier–Roussy
sarcoidosis) with extensive disease on positron emission tomography: A case report and review of the literature. Respirol Case Rep 2022; 10:e0949. [PMID: 35433008 PMCID: PMC8995833 DOI: 10.1002/rcr2.949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/08/2022] [Accepted: 03/27/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Paul Youn
- Department of Respiratory MedicineSir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
| | - Roslyn J. Francis
- Department of Nuclear MedicineSir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
- Medical SchoolUniversity of Western AustraliaNedlandsWestern AustraliaAustralia
| | - Henry Preston
- Fremantle Pathology Pty LtdFremantleWestern AustraliaAustralia
| | - Fiona Lake
- Department of Respiratory MedicineSir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia
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8
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Abstract
Only a few series of patients with systemic sarcoidosis and specific subcutaneous lesions have been reported. We reviewed our patients with systemic sarcoidosis with specific subcutaneous lesions to analyze their histopathological features and their relationship with clinical features of the systemic disease. Patients with systemic sarcoidosis with predominantly subcutaneous sarcoid granulomas diagnosed between 1980 and 2016 in Bellvitge University Hospital were enrolled. We also analyzed patients with clinically and histopathologically identical lesions in whom a diagnosis of systemic sarcoidosis could not be made during follow-up. Twenty-eight patients with systemic sarcoidosis presented specific subcutaneous lesions (23 women and 5 men, mean age 55.64 SD 12.26 years). Dermal involvement was observed in 10 cases, always discrete and limited to deep reticular dermis. The distribution of the granulomatous infiltrate was lobular in 7 cases and lobular and septal in 21. Fibrosis was observed in 21 cases. There were no significant differences in persistence of lesions or persistence of systemic disease activity when comparing patients with and without fibrosis. In conclusion, fibrosis is a frequent finding in subcutaneous sarcoidosis, and although it may be intense, it is not associated with pulmonary fibrosis or with >2 years of persistence of systemic sarcoidosis activity.
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Lopez-Sundh AE, Maestre-Orozco T, Gonzalez-Vela MC, Fernandez-Ayala M. Subcutaneous sarcoidosis: A case series of 19 patients. J Postgrad Med 2021; 67:154-157. [PMID: 34341224 PMCID: PMC8445123 DOI: 10.4103/jpgm.jpgm_1072_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Subcutaneous sarcoidosis is a rare variant of this disease, whose relationship with systemic disease is still controversial. Our objective was to describe the clinical characteristics of a series of patients with subcutaneous sarcoidosis and to investigate the relationship between these skin lesions and the disease's activity, severity, and prognosis. Nineteen patients with biopsy-confirmed subcutaneous sarcoidosis between 2009 and 2019 were selected. Mean age at diagnosis was 53 years. Lung involvement was detected in 10 patients (52.6%), mainly in stages I and II. Only two patients (10.5%) had additional systemic signs and five patients (26%) suffered from other autoimmune diseases simultaneously. Six patients (31.6%) had elevated angiotensin-converting enzyme levels (mean level 174.5 U/L). Eight patients (42%) received treatment, mainly systemic corticosteroids, and all patients except for one had a favorable clinical outcome. Subcutaneous sarcoidosis is frequently associated with a mild form of systemic disease, and the prognosis seems favorable regardless of treatment. Sarcoid nodules could be an early finding of systemic disease, allowing for less invasive procedures for histological confirmation.
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Affiliation(s)
- A E Lopez-Sundh
- Department of Dermatology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - T Maestre-Orozco
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - M C Gonzalez-Vela
- Department of Pathology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - M Fernandez-Ayala
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Abstract
Sarcoidosis is a chronic, multisystem, inflammatory disorder of unknown etiology that is characterized by noncaseating granulomas that impair normal organ functioning. Sarcoidosis predominantly affects the lungs, but the skin is often cited as the second most frequently involved organ. Cutaneous manifestations of sarcoidosis are highly variable and ongoing research seeks to better understand the relationship between clinical morphology and disease prognosis. Skin findings in patients with sarcoidosis can be "specific," in which sarcoidal granulomas infiltrate the skin, or they can represent a "nonspecific" reactive inflammatory process, as is seen in calcinosis cutis and erythema nodosum. Cutaneous sarcoidosis can be the initial presenting sign or develop later in the course of the disease. In some patients, the skin will be the most involved and impactful organ system and will drive therapy. In other cases, the skin will be an incidental or minor finding, but may be easily accessible for biopsy to confirm the diagnosis. There are many potential therapies for sarcoidosis, though no one therapy is universally effective.
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Affiliation(s)
- Avrom Caplan
- Ronald O. Perelman Department of Dermatology, NYU School of Medicine, New York, New York
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sotonye Imadojemu
- Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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11
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Cadieux D, Gupta R. Sarcoidosis presenting with intermediate uveitis and subcutaneous nodules. CMAJ 2020; 191:E1006. [PMID: 31501183 DOI: 10.1503/cmaj.190152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Dani Cadieux
- Department of Ophthalmology and Visual Sciences (Cadieux, Gupta), Dalhousie University, Halifax, NS
| | - Rishi Gupta
- Department of Ophthalmology and Visual Sciences (Cadieux, Gupta), Dalhousie University, Halifax, NS
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Mehrzad R, Festa J, Bhatt R. Subcutaneous sarcoidosis of the upper and lower extremities: A case report and review of the literature. World J Clin Cases 2019; 7:2505-2512. [PMID: 31559285 PMCID: PMC6745330 DOI: 10.12998/wjcc.v7.i17.2505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/25/2019] [Accepted: 07/27/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sarcoidosis is a granulomatous disease of unknown etiology that most often impacts the lungs. Cutaneous manifestations of sarcoidosis are seen among 9%-37% of patients. Subcutaneous sarcoidosis is a rare presentation of cutaneous sarcoidosis with estimates of frequency ranging from 1.4%-16%. To date, very few articles and case reports have been written about this subject. In this paper, we describe a case of subcutaneous sarcoidosis and perform a review of the literature to determine if there are commonalities among patients who present with subcutaneous sarcoidosis.
CASE SUMMARY A 38-year-old female, with a past medical history of arthritis and recurrent nephrolithiasis, presents with an 8-mo history of 4 firm, asymptomatic, skin-colored nodules on her left and right upper extremities and neck. Needle biopsy and post-excisional pathology report both revealed well-formed, dense, non-caseating granulomas localized to the subcutaneous tissue. Chest computed tomography revealed mild mediastinal lymphadenopathy. A diagnosis of subcutaneous sarcoidosis was made, and the lesions were surgically removed.
CONCLUSION Commonalities among patients presenting with subcutaneous sarcoidosis include: middle-aged female, lesions localizing to the upper or lower limbs, lymphadenopathy or pulmonary infiltration on chest imaging, elevated serum angiotensin-converting enzyme.
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Affiliation(s)
- Raman Mehrzad
- Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, the Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Julia Festa
- Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, the Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
| | - Reena Bhatt
- Department of Plastic and Reconstructive Surgery, Rhode Island Hospital, the Warren Alpert Medical School of Brown University, Providence, RI 02903, United States
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18F-FDG PET/CT of sarcoidosis with extensive cutaneous and subcutaneous nodules: the snow leopard sign. Eur J Nucl Med Mol Imaging 2019; 46:1980-1981. [PMID: 31123764 DOI: 10.1007/s00259-019-04353-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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Ko KM, Moon SJ, Koh JH, Kim J, Min JK. A Rare Case of Overlap Syndrome with Diffuse Systemic Sclerosis, Rheumatoid Arthritis, and Cutaneous Sarcoidosis. JOURNAL OF RHEUMATIC DISEASES 2019. [DOI: 10.4078/jrd.2019.26.4.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kyung Min Ko
- Division of Rheumatology, Department of Internal Mediciney, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Su-Jin Moon
- Division of Rheumatology, Department of Internal Mediciney, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hee Koh
- Division of Rheumatology, Department of Internal Mediciney, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeana Kim
- Department of Pathology, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Ki Min
- Division of Rheumatology, Department of Internal Mediciney, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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YKL-40, Soluble IL-2 Receptor, Angiotensin Converting Enzyme and C-Reactive Protein: Comparison of Markers of Sarcoidosis Activity. Biomolecules 2018; 8:biom8030084. [PMID: 30154391 PMCID: PMC6164141 DOI: 10.3390/biom8030084] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 08/17/2018] [Accepted: 08/23/2018] [Indexed: 01/22/2023] Open
Abstract
The aims of this study were to describe the clinical, radiological and immunological features of a population of sarcoidosis patients and to analyse chitinase-3-like protein 1 (YKL-40), soluble interleukin-2 receptor (sIL-2R), neopterin concentrations and adenosine deaminase (ADA) activity in serum of these patients in order to understand their potential as disease markers. Fifty-nine patients affected by chronic sarcoidosis, in active (20 patients) and inactive (39 patients) phase according to the clinical, radiological and laboratory criteria were studied. Serum YKL-40, sIL-2R, high-sensitive C-reactive protein (hs-CRP), neopterin levels and ADA activities were evaluated and compared with those of 25 healthy controls. Individuals with chronic sarcoidosis were significantly higher serum YKL-40, sIL-2R, neopterin, hs-CRP concentrations, angiotensin converting enzyme (ACE) and ADA activity than those of control subjects. Sarcoidosis patients in the active phase of the disease were significantly higher YKL-40, sIL-2R, hs-CRP levels and ACE activity than those in the inactive phase, while ADA activities and neopterin levels did not display any significant difference between the active and inactive disease groups. In comparison to the other parameters, as panel measurement of the serum YKL-40, sIL-2R, ACE and hs-CRP indicate a greater discrimination between active and inactive disease. The results indicate that serum YKL-40, sIL-2R, ACE and hs-CRP concentrations may be useful marker for monitoring sarcoidosis disease activity.
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Abstract
PURPOSE OF REVIEW Cutaneous sarcoidosis occurs in up to 30% of patients with sarcoidosis and skin findings are often the initial presenting symptom. Cutaneous sarcoidosis is a rare skin disease and many aspects of the disease presentation and treatment are not well understood. This review will highlight developments in the epidemiology, clinical presentation, diagnosis and treatment of cutaneous sarcoidosis over the past several years. RECENT FINDINGS Epidemiological studies from several different populations reaffirm that cutaneous sarcoidosis is more common in women and is often the presenting symptom of systemic sarcoidosis. Recently, more cases are being reported in association with oncologic immune modulators, which will be of great interest as use of those agents increases. Also, ultrasound has shown promise for the imaging of cutaneous granulomas for disease assessment and measuring response to treatment. Finally, the treatment of cutaneous sarcoidosis remains difficult and is based largely on retrospective data with a paucity of large, prospective trials. There have been recently introduced and validated cutaneous scoring tools which show promise and may lead to more high-quality studies going forward. SUMMARY The recent developments in cutaneous sarcoidosis have identified many new pharmacologic and physical triggers of disease, but the evidence for effective treatment is still lacking. Further research is necessary to improve the care of patients with cutaneous sarcoidosis.
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