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McLennan AL, Cockerell CJ, Ren VZ. Sarcoidosis Resembling Angiokeratomas: A Case Report. Cureus 2024; 16:e56322. [PMID: 38628994 PMCID: PMC11020630 DOI: 10.7759/cureus.56322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Sarcoidosis, a multifaceted systemic disorder characterized histologically by the presence of non-caseating granulomas, has a wide array of cutaneous manifestations. We describe a case of a 74-year-old woman with a complex medical history, who presented with asymptomatic hyperpigmented papules on her lower extremities. Histological examination of a punch biopsy specimen showed nodular and angiocentric patterns of granulomatous inflammation consistent with sarcoidosis, and chest radiography demonstrated bilateral hilar opacities, supporting the diagnosis. To our knowledge, this specific cutaneous presentation of sarcoidosis has not been described before, and it can easily be mistaken for other conditions. Therefore, this case underscores the importance of recognizing atypical cutaneous morphologies of sarcoidosis, particularly in patients with complex medical histories, to facilitate accurate diagnosis and timely intervention. We aim to increase awareness among clinicians regarding the diverse manifestations of sarcoidosis, thereby enhancing diagnostic acumen and patient care.
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Affiliation(s)
| | | | - Vicky Z Ren
- Dermatology, Baylor College of Medicine, Houston, USA
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2
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Aktas M, Tunc H, Zaben B, Arı N, Midi I, Cinel L, Ergun T. An unusual diagnosis for sporotrichoid nodular lesions: Subcutaneous sarcoidosis. Indian J Dermatol Venereol Leprol 2023; 0:1-2. [PMID: 37609755 DOI: 10.25259/ijdvl_582_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 05/21/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Meryem Aktas
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Handenur Tunc
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Baha Zaben
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nursah Arı
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ipek Midi
- Department of Neurology, Marmara University School of Medicine, Istanbul, Turkey
| | - Leyla Cinel
- Department of Pathology, Marmara University School of Medicine, Istanbul, Turkey
| | - Tulin Ergun
- Department of Dermatology, Marmara University School of Medicine, Istanbul, Turkey
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Systemic Sarcoidosis Presenting in a Scar. Case Rep Dermatol Med 2023; 2023:7751754. [PMID: 36733915 PMCID: PMC9889162 DOI: 10.1155/2023/7751754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/30/2022] [Accepted: 12/17/2022] [Indexed: 01/25/2023] Open
Abstract
While most forms of sarcoidosis of the skin do not require treatment, 40% of patients initially diagnosed with cutaneous sarcoidosis are found to have an asymptomatic disease involving other organ systems. It is the involvement of the lungs, heart, eyes, and nervous system which most often contributes to morbidity/mortality. An early and accurate diagnosis of sarcoidosis is difficult because patients may be asymptomatic, initial presentations may vary, and there is no single reliable diagnostic test except biopsy. We present a case of scar sarcoidosis which led to the diagnosis of stage II pulmonary sarcoidosis in a woman in her 50s. Her scar sarcoidosis presented as well-circumscribed, reddish-brown macules surrounding an atrophic scar from a prior skin graft on the right leg. Biopsy revealed scattered, well-formed, non-necrotizing granulomas of the dermis composed of epithelioid histiocytes and multinucleated giant cells, surrounded by a sparse infiltrate of lymphocytes and histiocytes. A CT chest demonstrated extensive hilar lymphadenopathy, leading to a diagnosis of stage II pulmonary sarcoidosis with cutaneous involvement. This case illustrates the interesting presentation of scar sarcoidosis and underscores the importance of a broad differential including sarcoidosis for skin changes around scars and underscores the need for early biopsy. Prompt cutaneous diagnosis leads to earlier systemic evaluation, therapeutics, and better outcomes.
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4
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K S, Rout AN, Asati DP, Panwar H. Foamy histiocytes in sarcoidosis! Puzzle resolved with the aid of tattoo. Indian J Dermatol Venereol Leprol 2023; 89:84-87. [PMID: 36331865 DOI: 10.25259/ijdvl_89_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/01/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Shreya K
- Department of Dermatology, STD & Leprosy, AIIMS, Bhopal, Madhya Pradesh, India
| | - Arpita N Rout
- Department of Dermatology, STD & Leprosy, AIIMS, Bhopal, Madhya Pradesh, India
| | - Dinesh P Asati
- Department of Dermatology, STD & Leprosy, AIIMS, Bhopal, Madhya Pradesh, India
| | - Hemlata Panwar
- Department of Pathology and Lab Medicine, AIIMS, Bhopal, Madhya Pradesh, India
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Boch K, Langan EA, Zillikens D, Ludwig RJ, Kridin K. Evaluation of clinical and laboratory characteristics of patients with cutaneous sarcoidosis: A single-center retrospective cohort study. Front Med (Lausanne) 2022; 9:980507. [PMID: 36300194 PMCID: PMC9589039 DOI: 10.3389/fmed.2022.980507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Cutaneous sarcoidosis is a relatively rare disease whose clinical manifestations include red-brown macules, plaques, papules and subcutaneous nodules. The skin changes may also be restricted to pre-existing scars. Cutaneous sarcoidosis can be associated with systemic organ involvement. Objectives Aim of this retrospective study was to longitudinally investigate clinical and laboratory findings in patients with cutaneous sarcoidosis. Methods Patients (>18 years) with histologically confirmed cutaneous sarcoidosis between January 2014 and December 2020 were included. Patient demographics, clinical features, laboratory and radiological findings, management, clinical outcomes and co-morbidities associated with cutaneous sarcoidosis were analyzed. Results Thirty-seven patients with cutaneous sarcoidosis were identified, of whom 57% were female. The most common clinical phenotype of cutaneous sarcoidosis was papular sarcoidosis (n = 16), while plaques and nodules were present in 9 patients. In contrast, subcutaneous (n = 1) and scar-associated sarcoidosis (n = 1) were rare. Of patients with systemic disease, the cutaneous disease followed, preceded, and coincided with the development of systemic sarcoidosis in 2, 9, and 12 patients, respectively. Levels of soluble interleukin (IL)-2 receptor, angiotensin converting enzyme (ACE), and C-reactive protein (CRP) were elevated, in 76%, 21%, and 50% of the tested patients respectively and predicted systemic involvement. Hypercalcemia was present in 6% of patients. Female sex and younger age (<54 years) were significantly associated with systemic manifestations. Conlcusions Cutaneous sarcoidosis was frequently associated with additional systemic involvement, particularly when present in young females. 24 % of patients with cutaneous sarcoidosis developed additional organ involvement during follow-up.
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Affiliation(s)
- Katharina Boch
- Department of Dermatology, University of Lübeck, Lübeck, Germany,*Correspondence: Katharina Boch
| | - Ewan A. Langan
- Department of Dermatology, University of Lübeck, Lübeck, Germany,Manchester Sciences, University of Manchester, Manchester, United Kingdom
| | - Detlef Zillikens
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf J. Ludwig
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany,Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Perspective of sarcoidosis in terms of rheumatology: a single-center rheumatology clinic experience. Rheumatol Int 2022; 42:2191-2197. [PMID: 36006458 DOI: 10.1007/s00296-022-05193-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 08/16/2022] [Indexed: 10/15/2022]
Abstract
Sarcoidosis may present with many rheumatological symptoms as well as mimic and/or may occur concomitantly with many other rheumatic diseases. We examined the demographic, clinical and laboratory characteristics of patients diagnosed with sarcoidosis in the rheumatology department. This study planned as retrospective cross-sectional study. Medical records of patients who applied to our rheumatology outpatient clinic due to complain of musculoskeletal problems and then diagnosed sarcoidosis were retrospectively investigated. Joint findings, extrapulmonary involvements, and coexisting rheumatic disease were evaluated. Fifty-six patients (41.21 ± 7.83 years, 75% female) were included. The duration of the disease was 49.61 ± 29.11 months, and the follow-up period was 26.66 ± 13.26 months. All patients had pulmonary system involvement. Arthralgia was present in 91.10% of 56 patients and arthritis in 89.29% of patients. Examining the subtypes of the arthritis findings, mono-arthritis was found in 31/50 (62%) patients, oligo-arthritis in 15/50 (30%) patients, and polyarthritis in 4/50 (8%) patients. A total of 11 (19.60%) patients were diagnosed with uveitis. Excision of the mediastinal LAP was performed in a total of 37 patients (66.1%) and became the most commonly employed method. Considering the treatment distribution of the patients under followed-up, it is seen that non-steroidal anti-inflammatory treatments were used in 15 (26.8%) patients, corticosteroids in a total of 40 (71.4%) patients, methotrexate in a total of 15 patients (26.8%), azathioprine in six (10.7%) patients, hydroxychloroquine in 14 (25%) patients, and infliximab in one (1.8%) patient. As sarcoidosis is a mimicking disease, a good differential diagnosis should be made to avoid misdiagnosis and in order not to be late in diagnosis and treatment. Physicians, especially rheumatologists, should remember sarcoidosis more frequently as the disease may overlap with other rheumatological diseases and may occur with many rheumatological manifestations.
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7
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Pelzer T, Buck A, Gernert M, Giner T, Haarmann A, Jung P. [Sarcoidosis - the chameleon of internal medicine]. MMW Fortschr Med 2022; 164:52-59. [PMID: 35817919 DOI: 10.1007/s15006-022-1173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Theo Pelzer
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany.
| | - Andreas Buck
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
| | - Michael Gernert
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
| | - Tina Giner
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Josef-Schneider-Str. 2,, 97080, Würzburg, Germany
| | - Axel Haarmann
- Neurologische klinik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 11, 97080, Würzburg, Germany
| | - Pius Jung
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
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8
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Kök GF, Türsen Ü. The Immunogenetics of Granulomatous Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1367:349-368. [DOI: 10.1007/978-3-030-92616-8_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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9
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Pham JP, Star P, Wong S, Damian DL, Saw RPM, Whitfeld MJ, Menzies AM, Joshua AM, Smith A. Cutaneous sarcoidosis due to immune‐checkpoint inhibition and exacerbated by a novel BRAF dimerization inhibitor. SKIN HEALTH AND DISEASE 2021; 1:e71. [PMID: 35663773 PMCID: PMC9060087 DOI: 10.1002/ski2.71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/06/2021] [Accepted: 10/10/2021] [Indexed: 11/25/2022]
Abstract
Sarcoidosis is a non‐infective granulomatous disorder of unknown aetiology, with cutaneous involvement affecting up to 30% of patients. Drug‐induced sarcoidosis has been reported secondary to modern melanoma therapies including immune‐checkpoint inhibitors and first generation BRAF inhibitors such as vemurafenib and dabrafenib. Herein, we report a case of cutaneous micropapular sarcoidosis that first developed on immune‐checkpoint inhibition with ipilimumab and nivolumab for metastatic melanoma, which was exacerbated and further complicated by pityriasis rubra pilaris‐like palmar plaques upon transition to a next‐generation BRAF‐dimerisation inhibitor. Both the micropapular eruption and palmar plaques rapidly resolved after cessation of the novel BRAF‐inhibitor and concurrent commencement of hydroxychloroquine. It is unclear how inhibition of BRAF‐dimerisation results in granuloma formation, though upregulation of TH1/TH17 T‐cells and impairment of T‐reg cells may be responsible. Clinicians should be aware of the potential for exacerbation of sarcoidosis when transitioning from immune‐checkpoint inhibitors to these novel BRAF‐dimerisation inhibitors, particularly as their uptake in treating cancers increases beyond clinical trials. Further studies are required to assess whether these next‐generation agents can trigger sarcoidosis de‐novo, or simply exacerbate pre‐existing sarcoidosis.
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Affiliation(s)
- J. P. Pham
- St Vincent's Hospital Sydney New South Wales Australia
- St Vincent's Clinical School University of New South Wales Darlinghurst New South Wales Australia
| | - P. Star
- St Vincent's Hospital Sydney New South Wales Australia
| | - S. Wong
- St Vincent's Hospital Sydney New South Wales Australia
| | - D. L. Damian
- Melanoma Institute of Australia The University of Sydney Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Royal Prince Alfred Hospital Camperdown New South Wales Australia
| | - R. P. M. Saw
- Melanoma Institute of Australia The University of Sydney Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Royal Prince Alfred Hospital Camperdown New South Wales Australia
| | - M. J. Whitfeld
- St Vincent's Hospital Sydney New South Wales Australia
- St Vincent's Clinical School University of New South Wales Darlinghurst New South Wales Australia
- The Skin Hospital Darlinghurst New South Wales Australia
| | - A. M. Menzies
- Melanoma Institute of Australia The University of Sydney Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Royal North Shore and Mater Hospitals Sydney New South Wales Australia
| | - A. M. Joshua
- St Vincent's Hospital Sydney New South Wales Australia
- St Vincent's Clinical School University of New South Wales Darlinghurst New South Wales Australia
| | - A. Smith
- St Vincent's Hospital Sydney New South Wales Australia
- Melanoma Institute of Australia The University of Sydney Sydney New South Wales Australia
- Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- The Skin Hospital Darlinghurst New South Wales Australia
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Mahabal GD, Peter DCV, George L, Thomas M, Pulimood SA. Cutaneous Sarcoidosis: A Retrospective Clinico-Pathological Study from the Indian Subcontinent in Patients Attending a Tertiary Health Care Centre. Indian Dermatol Online J 2021; 12:566-571. [PMID: 34430461 PMCID: PMC8354409 DOI: 10.4103/idoj.idoj_606_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/12/2020] [Accepted: 03/01/2021] [Indexed: 01/19/2023] Open
Abstract
Context: Sarcoidosis is a systemic disorder characterized histologically by noncaseating granulomas. There is paucity of Indian data on cutaneous sarcoidosis. Aims: To describe the clinical, histopathological findings, and extracutaneous involvement in cutaneous sarcoidosis. Materials and Methods: A retrospective study was done in patients of cutaneous sarcoidosis who had attended the dermatology clinic of a tertiary health care center in India from May 2009 to April 2015. The clinical details, histopathological findings, treatment, and response were reviewed. Results: There were 38 patients with cutaneous sarcoidosis. Mean age was 48 ± 13 years; 58% were female. Median duration of disease was 11 months (IQR 4–48 months). More than one morphology was seen in 28.9%, commonest being plaques (65.7%), and papules (50%). Erythema nodosum was rare. More than one site was involved in 55.3%, most commonly trunk (52.6%). Six patients had isolated cutaneous sarcoidosis. Commonest extracutaneous organs involved were lung (73.7%) and lymph nodes (68.4%). Histopathologically, classical naked sarcoidal granulomas were found in only 55.3%. Angiotensin converting enzyme (ACE) levels were elevated in 74.3% (26/35) with significant association with extracutaneous disease. Treatment included topical and/or systemic corticosteroids, hydroxychloroquine, and tacrolimus. Statistics: Pearson's Chi-square test was done to analyze associations between the skin lesions, ACE levels, and systemic involvement; P < 0.05 was considered significant. Conclusions: Cutaneous manifestations of sarcoidosis are varied, commonest being erythematous plaques. Even though most patients had systemic involvement, we found no significant association of the type and number of skin lesions with extracutaneous involvement or prognosis. Elevated ACE levels were significantly associated with systemic involvement.
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Affiliation(s)
- Gauri D Mahabal
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Dincy C V Peter
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Leni George
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Meera Thomas
- Department of Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Susanne A Pulimood
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
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11
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El Jazouly M, Chahboun F, Kelati A, El Omari M, Al Bouzidi A, Chiheb S. [Scar sarcoidosis: a usually progressive disease (about a case)]. Pan Afr Med J 2021; 39:268. [PMID: 34707769 PMCID: PMC8520421 DOI: 10.11604/pamj.2021.39.268.27864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/02/2021] [Indexed: 11/11/2022] Open
Abstract
The sarcoidosis is a systemic granulomatous disease. It is usually characterized by skin manifestations which may be suggestive of progressive sarcoidosis with visceral involvement. We here report a case of pulmonary sarcoidosis revealed by the reactivation of an old cutaneous scar following a trauma occurred 20 years earlier. Radiological assessment showed mediastino-pulmonary sarcoidosis stage 2. The diagnosis of sarcoidosis should be suspected in patients with any recent scar modification in order to establish early management.
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Affiliation(s)
- Madiha El Jazouly
- Service de Dermatologie, Hôpital Cheikh Khalifa Ibn Zaid, Université Mohammed VI des Sciences de la Santé de Casablanca, Casablanca, Maroc
| | - Fatimzahra Chahboun
- Service de Dermatologie, Hôpital Cheikh Khalifa Ibn Zaid, Université Mohammed VI des Sciences de la Santé de Casablanca, Casablanca, Maroc
| | - Awatef Kelati
- Service de Dermatologie, Hôpital Cheikh Khalifa Ibn Zaid, Université Mohammed VI des Sciences de la Santé de Casablanca, Casablanca, Maroc
| | - Mounia El Omari
- Service de Chirurgie Plastique, Hôpital Cheikh Khalifa Ibn Zaid, Université Mohammed VI des Sciences de la Santé de Casablanca, Casablanca, Maroc
| | - Abderahman Al Bouzidi
- Service d´Anatomopathologie, Hôpital Cheikh Khalifa Ibn Zaid, Université Mohammed VI des Sciences de la Santé de Casablanca, Casablanca, Maroc
| | - Soumiya Chiheb
- Service de Dermatologie, Hôpital Cheikh Khalifa Ibn Zaid, Université Mohammed VI des Sciences de la Santé de Casablanca, Casablanca, Maroc
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12
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Chaabani M, Hafsi W, Alaoui F, Sassi W, Mokni M. Generalized ulcerative cutaneous sarcoidosis: an unusual presentation of the disease. Int J Dermatol 2021; 61:e111-e112. [PMID: 34363626 DOI: 10.1111/ijd.15846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/12/2021] [Accepted: 07/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Meryam Chaabani
- Department of Dermatology, Rabta Hospital of Tunis, Tunis, Tunisia
| | - Wissem Hafsi
- Department of Dermatology, Rabta Hospital of Tunis, Tunis, Tunisia
| | - Fatima Alaoui
- Department of Dermatology, Rabta Hospital of Tunis, Tunis, Tunisia
| | - Wiem Sassi
- Department of Dermatology, Rabta Hospital of Tunis, Tunis, Tunisia
| | - Mourad Mokni
- Department of Dermatology, Rabta Hospital of Tunis, Tunis, Tunisia
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13
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Abed Dickson M, Hernández BA, Marciano S, Mazzuoccolo LD. Prevalence and characteristics of cutaneous sarcoidosis in Argentina. Int J Womens Dermatol 2021; 7:280-284. [PMID: 34222584 PMCID: PMC8243117 DOI: 10.1016/j.ijwd.2021.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/29/2020] [Accepted: 01/06/2021] [Indexed: 01/19/2023] Open
Abstract
Background Sarcoidosis is a multisystem granulomatous disease of unknown etiology. The incidence is higher in women than in men, according to some studies. Studies regarding prevalence and characteristics of cutaneous sarcoidosis in our region are scarce. Objective This study aimed to describe the characteristics of patients with cutaneous sarcoidosis and to estimate its prevalence. Methods A cross-sectional study was conducted of patients with cutaneous sarcoidosis between January 1, 2004 and April 30, 2019 at the Hospital Italiano de Buenos Aires in Argentina. We included all patients age >17 years with biopsy-proven cutaneous sarcoidosis. Isolated cutaneous sarcoidosis was defined as the presence of epithelioid noncaseating granulomas on a skin biopsy without further evidence of systemic involvement. To estimate period prevalence, we only considered the subgroup of patients affiliated with our private health system. Results A total of 38 patients with cutaneous sarcoidosis were included. The median age at the time of diagnosis was 55.5 years. There was a striking female predominance in our series (73.7%). Overall, 15 patients (39.5%) had isolated cutaneous sarcoidosis and 23 (60.5%) had systemic sarcoidosis with cutaneous involvement. The median follow-up of the study population from histological diagnosis was 50 months (interquartile range, 24–10 months). Regarding skin involvement, 28 patients (73.7%) presented with only sarcoidosis-specific lesions, 6 (15.8%) presented with erythema nodosum, and 4 (10.5%) presented with both sarcoidosis-specific lesions and erythema nodosum. Treatment was given to 29 patients (73.6%), with systemic and topical corticosteroids being the most frequent. The crude prevalence of cutaneous sarcoidosis was 16.9 (95% confidence interval, 10.6–25.5) per 100,000 persons. Conclusion One of the major findings of our study was that 40% of patients had isolated cutaneous sarcoidosis.
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14
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Araghi F, Tabary M, Rakhshan A, Dadkhahfar S, Robati RM. Necrobiosis lipoidica-like lesions in a nondiabetic patient with systemic sarcoidosis: A case report and review of the literature. Clin Case Rep 2020; 8:2782-2786. [PMID: 33363822 PMCID: PMC7752443 DOI: 10.1002/ccr3.3281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/05/2020] [Accepted: 08/06/2020] [Indexed: 11/11/2022] Open
Abstract
Necrobiosis lipoidica-like lesions, in known cases of sarcoidosis, can be considered as a member of the broad spectrum of histologic changes in sarcoidosis.
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Affiliation(s)
- Farnaz Araghi
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | | | - Azadeh Rakhshan
- Department of PathologyShohada‐e‐Tajrish Educational HospitalSchool of MedicineShahid Beheshti University of Medical SciencesTehranIran
| | - Sahar Dadkhahfar
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Reza M. Robati
- Skin Research CenterShahid Beheshti University of Medical SciencesTehranIran
- Department of DermatologyLoghman Hakim HospitalShahid Beheshti University of Medical SciencesTehranIran
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15
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Tisack A, Jiang A, Veenstra J. Crusted, ulcerated plaques on the scalp and face. Clin Exp Dermatol 2020; 46:199-202. [PMID: 32959399 DOI: 10.1111/ced.14441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Tisack
- Wayne State University School of Medicine, Detroit, MI, USA
| | - A Jiang
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
| | - J Veenstra
- Department of Dermatology, Henry Ford Health System, Detroit, MI, USA
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16
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Duffens A, Kraus CN, Elsensohn AN, Shiu J, Smith J. Ichthyosiform red-brown plaques on bilateral shins. JAAD Case Rep 2020; 6:838-840. [PMID: 32885011 PMCID: PMC7452344 DOI: 10.1016/j.jdcr.2020.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/30/2022] Open
Affiliation(s)
- Ali Duffens
- School of Medicine, University of California, Irvine, California
| | - Christina N Kraus
- Department of Dermatology, University of California, Irvine, California
| | - Ashley N Elsensohn
- Section of Dermatopathology, Geisinger Medical Center, Danville, Pennsylvania
| | - Jessica Shiu
- Department of Dermatology, University of California, Irvine, California
| | - Janellen Smith
- Department of Dermatology, University of California, Irvine, California
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17
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Inoue Y, Teraki Y. Association of Propionibacterium acnes with the efficacy of minocycline therapy for cutaneous sarcoidosis. Int J Dermatol 2020; 59:704-708. [PMID: 32333400 DOI: 10.1111/ijd.14878] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/16/2020] [Accepted: 03/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although tetracycline has been used to treat cutaneous sarcoidosis, the mechanism of action for this treatment remains unclear. This study evaluated the efficacy of minocycline treatment on cutaneous sarcoidosis and the relationship between its efficacy and the presence of Propionibacterium acnes in skin sarcoid lesions. METHODS We retrospectively reviewed results in 13 patients with cutaneous sarcoidosis treated with minocycline at Saitama Medical Center between 2010 and 2017. To demonstrate the presence of P. acnes in the skin lesions, skin biopsy specimens from 11 of the 13 patients were evaluated with immunohistochemistry using a specific monoclonal antibody against P. acnes (PAB antibody). RESULTS Of the 13 patients treated with minocycline, six patients (46%) achieved a complete response (CR) and seven (54%) had a partial response (PR). The skin lesions regressed in 1.5-5 months (average, 3.2 months) after treatment with minocycline. No relapse had occurred during the minocycline therapy. Elevated serum angiotensin-converting enzyme levels were observed in five of the patients, and the levels reduced after treatment with minocycline. P. acnes, identified as round bodies that reacted with PAB antibody, were observed in the skin sarcoid granulomas in all patients tested. The number of PAB-positive round bodies was significantly higher in the skin lesions of patients who had CR than in those who had PR. CONCLUSIONS These results suggest the effectiveness of minocycline for the treatment of cutaneous sarcoidosis and an association of P. acnes with the efficacy of minocycline therapy for cutaneous sarcoidosis.
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Affiliation(s)
- Yumiko Inoue
- Department of Dermatology, Saitama Medical University, Saitama Medical Center, Saitama, Japan
| | - Yuichi Teraki
- Department of Dermatology, Saitama Medical University, Saitama Medical Center, Saitama, Japan
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Izhakoff N, Ojong O, Ilyas M, Guridi R, Lobos C, Druck PA, Zaiac MN. Platelet-rich plasma injections and the development of cutaneous sarcoid lesions: A case report. JAAD Case Rep 2020; 6:348-350. [PMID: 32258318 PMCID: PMC7103666 DOI: 10.1016/j.jdcr.2020.02.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Nicole Izhakoff
- Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
- Correspondence to: Nicole Izhakoff, BA, Herbert Wertheim College of Medicine, Florida International University, 2200 NE 201 Street, Miami, FL 33180.
| | - Oben Ojong
- Department of Dermatology, Larkin Community Hospital Palm Springs Campus, Hialeah, Florida
| | - Muneeb Ilyas
- Department of Dermatology, Larkin Community Hospital Palm Springs Campus, Hialeah, Florida
| | - Rodrigo Guridi
- Department of Plastic Surgery, Clínica Las Condes, Santiago, Chile
| | - Carolina Lobos
- Department of Dermatology, Clínica Las Condes, Santiago, Chile
| | | | - Martin N. Zaiac
- Department of Dermatology, Herbert Wertheim College of Medicine, Florida International University, Miami, Florida
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Zhu X, Sun J. A case of facial atrophic sarcoidosis in an adolescent, successfully treated with the combination of prednisone and hydroxychloroquine. An Bras Dermatol 2020; 95:340-342. [PMID: 32299736 PMCID: PMC7253884 DOI: 10.1016/j.abd.2019.08.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 08/04/2019] [Indexed: 11/30/2022] Open
Abstract
Sarcoidosis is a multisystem granulomatous disorder of unknown aetiology. Cutaneous involvement occurs in up to 30% of patients and skin findings are often the initial presenting symptom. The facial atrophic form of sarcoidosis without associated ulceration in adolescents has rarely been described in the literature. We report a case of 13-year-old male patient with a facial atrophic sarcoidosis who was successfully treated with the combination of prednisone and hydroxychloroquine.
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Affiliation(s)
- Xiaomei Zhu
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China.
| | - Jianfang Sun
- Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences, Peking Union Medical College, Nanjing, China.
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Isohisa T, Asai J, Kanemaru M, Arita T, Tsutsumi M, Kaneko Y, Arakawa Y, Wada M, Konishi E, Katoh N. CD163-positive macrophage infiltration predicts systemic involvement in sarcoidosis. J Cutan Pathol 2020; 47:584-591. [PMID: 32125018 DOI: 10.1111/cup.13675] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/17/2020] [Accepted: 02/26/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Sarcoidosis is a chronic and systemic inflammatory disease, in which patients present with noncaseating epithelioid granulomas. Cutaneous lesions of sarcoidosis develop in 9% to 35% of all sarcoidosis patients and comprise various clinical subtypes. It usually affects multiple organs and has a variable clinical course; this is called systemic sarcoidosis (SS). However, occasionally, it only affects the skin and is then called cutaneous sarcoidosis (CS). Recent observations suggest that serum levels of soluble CD163 correlate with immune cell activity in sarcoidosis patients; however, the contribution of M1 and M2 macrophages toward disease progression remains unclear. METHODS We evaluated macrophage phenotypes histopathologically using skin biopsy samples obtained from patients with CS (n = 8) and SS (n = 31) and performed immunostaining with CD68, iNOS (M1 macrophages), PD-L1, and CD163 (M2 macrophages). RESULTS The density of CD163-positive cells in the SS group was significantly higher than that in the CS group. There was no significant correlation between the CD163 (+) cell density and serum angiotensin-converting enzyme level, serum calcium, or tuberculin reaction. CONCLUSIONS Immunostaining for CD163 may be a novel and useful marker to predict systemic involvement in patients with cutaneous lesions of epithelioid granulomas.
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Affiliation(s)
- Taro Isohisa
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Jun Asai
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Mai Kanemaru
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Takahiro Arita
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Miho Tsutsumi
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Yuka Kaneko
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Yukiyasu Arakawa
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Makoto Wada
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Eiichi Konishi
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
| | - Norito Katoh
- Department of Dermatology, Kyoto Prefectural University of Medicine Graduate School of Medical Science, Kyoto, Japan
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Cutaneous sarcoidosis: clinico-epidemiological profile of 72 patients at a tertiary hospital in São Paulo, Brazil. An Bras Dermatol 2019; 95:57-62. [PMID: 31889592 PMCID: PMC7058863 DOI: 10.1016/j.abd.2019.06.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 06/17/2019] [Indexed: 11/30/2022] Open
Abstract
Background Sarcoidosis is a multisystem disease of unknown cause that is characterized by the presence of granulomas in various organs. Cutaneous involvement is common and the reported incidence has varied from 9% to 37%. Studies on cutaneous sarcoidosis in Brazil are lacking. Objectives To describe the clinical and epidemiological aspects of patients with cutaneous sarcoidosis diagnosed at the Department of Dermatology of the University of São Paulo, from May 1994 to March 2018. Methods Clinical data of patients with confirmed cutaneous sarcoidosis were retrospectively reviewed and classified according to gender, ethnicity, age at diagnosis, cutaneous presentation, systemic involvement and treatment. Results Cutaneous sarcoidosis was diagnosed in 72 patients with a female predominance (74%). The mean age at diagnosis was 49.6 years and most of the patients were white (61%). Papules and plaques were the most common lesions. Systemic sarcoidosis was detected in 81% of patients, affecting mainly the lungs and thoracic lymph nodes (97%). Typically, cutaneous lesions were the first manifestation (74%). Systemic therapy was necessary for 72% of patients; the dermatologist managed many of these cases. Oral glucocorticoids were the most commonly used systemic medication (92%). The mean number of systemic drugs used was 1.98 per patient. Limitations Insufficient data in medical records. Conclusions This series highlights the dermatologist role in recognizing and diagnosing cutaneous sarcoidosis, evaluating patients for systemic disease involvement and treating the skin manifestations. Cutaneous sarcoidosis was once considered exceedingly infrequent in Brazil in comparison to infectious granulomatous diseases; however, the present series seems to suggest that the disease is not so rare in this region.
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Prohaska J, Demaree E, Powers J, Cook C. Scalp Sarcoidosis Presenting as Cicatricial Alopecia. J Osteopath Med 2019; 118:824-826. [PMID: 30476994 DOI: 10.7556/jaoa.2018.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Sarcoidosis is a granulomatous condition that has a highly variable presentation. One rare presentation of sarcoidosis is cutaneous scalp sarcoidosis. Usually scalp sarcoid presents as a scarring alopecia, but it can be nonscarring. The presence of sarcoidal lesions on the scalp is associated with systemic disease, as are other cutaneous manifestations of sarcoidosis. The authors present the case of a 64-year-old woman with a history of sarcoidosis who presented with alopecia and hypopigmented patches on her scalp. She also had papular sarcoid lesions on her upper back and a history of pulmonary involvement, which is consistent with previous reports in the literature. The condition subsequently improved with topical clobetasol propionate.
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23
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Starace M, Brandi N, Baraldi C, Piraccini BM, Alessandrini A. Scalp Sarcoidosis with Systemic Involvement: A Case Report and Literature Review. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10312099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Scalp sarcoidosis is generally uncommon and it may present itself with varying morphologies; therefore, it is important to differentiate this disease from other forms of cicatricial and non-cicatricial causes of alopecia. Trichoscopy and histopathology are essential to rule out other skin diseases and to confirm diagnosis. Treatment options include topical, oral, and intralesional corticosteroids; immunosuppressive agents; and hydroxychloroquine, in order to arrest the progression of alopecia. Here, the authors present a case of scalp sarcoidosis with systemic involvement, in which dermoscopy gives important clues for its diagnosis. The authors have also reviewed the literature and identified 46 cases of sarcoidosis that induced alopecia.
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Affiliation(s)
- Michela Starace
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Nicolò Brandi
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Carlotta Baraldi
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Bianca Maria Piraccini
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
| | - Aurora Alessandrini
- Department of Experimental, Diagnostic and Specialty Medicine, Division of Dermatology, University of Bologna, Bologna, Italy
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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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Ungprasert P, Ryu JH, Matteson EL. Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis. Mayo Clin Proc Innov Qual Outcomes 2019; 3:358-375. [PMID: 31485575 PMCID: PMC6713839 DOI: 10.1016/j.mayocpiqo.2019.04.006] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 04/26/2019] [Indexed: 12/14/2022] Open
Abstract
The focus of this review is current knowledge about the epidemiology, clinical manifestations, diagnosis, and treatment of both pulmonary sarcoidosis and extrapulmonary sarcoidosis. Although intrathoracic involvement is the hallmark of the disease, present in over 90% of patients, sarcoidosis can affect virtually any organ. Clinical presentations of sarcoidosis are diverse, ranging from asymptomatic, incidental findings to organ failure. Diagnosis requires the presence of noncaseating granuloma and compatible presentations after exclusion of other identifiable causes. Spontaneous remission is frequent, so treatment is not always indicated unless the disease is symptomatic or causes progressive organ damage/dysfunction. Glucocorticoids are the cornerstone of treatment of sarcoidosis even though evidence from randomized controlled studies is lacking. Glucocorticoid-sparing agents and biologic agents are often used as second- and third-line therapy for patients who do not respond to glucocorticoids or experience serious adverse effects.
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Key Words
- ATS, American Thoracic Society
- AV, atrioventricular
- CMRI, cardiovascular magnetic resonance imaging
- DLCO, diffusing capacity of the lung for carbon monoxide
- DMARD, disease-modifying antirheumatic drugs
- ECG, electrocardiographic
- ERS, European Respiratory Society
- FDG-PET, 18F-fluorodeoxyglucose–positron emission tomography
- FVC, forced vital capacity
- GI, gastrointestinal tract
- LVEF, left ventricular ejection fraction
- NSAID, nonsteroidal anti-inflammatory drug
- PFT, pulmonary function test
- TBB, transbronchial lung biopsy
- TNF-α, tumor necrosis factor α
- WASOG, World Association of Sarcoidosis and other Granulomatous Disorders
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Affiliation(s)
- Patompong Ungprasert
- Clinical Epidemiology Unit, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Address to Patompong Ungprasert, MD, MS, Clinical Epidemiology Unit, 3rd Floor, SIMR Bldg, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.
| | - Jay H. Ryu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Eric L. Matteson
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Epidemiology, Department of Health Sciences Research (E.L.M.), Mayo Clinic, Rochester, MN
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Giner T, Benoit S, Kneitz H, Goebeler M. [Sarcoidosis : Dermatological view of a rare multisystem disease]. Hautarzt 2019; 68:526-535. [PMID: 28573316 DOI: 10.1007/s00105-017-4005-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Sarcoidosis is a rare multisystem inflammatory disease of largely unknown etiology. While pulmonary sarcoidosis is the most abundant organ manifestation, involvement of the skin that occurs in up to 30% of patients is the most common extrapulmonary presentation of the disease. Dermatologists therefore play an important role not only for establishing the diagnosis and delineating it from potential differential diagnoses but also for the interdisciplinary care of the patient. The clinical presentation of skin sarcoidosis is manifold, which occasionally aggravates making the final diagnosis. Specific skin lesions (with granulomas) and nonspecific skin manifestations (without granulomas) can be differentiated. Since a variety of organ systems can be affected, multidisciplinary cooperation is mandatory. Therapy of sarcoidosis is difficult; evidence-based studies and therapy guidelines are widely lacking. Our review intends to outline the characteristic clinical presentations of cutaneous sarcoidosis, describe the diagnostic approach and how to assure or exclude extracutaneous manifestations of sarcoidosis, and suggest a therapy algorithm for the treatment of skin sarcoidosis.
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Affiliation(s)
- T Giner
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland.
- Zentrum für Seltene Erkrankungen (ZESE) Nordbayern - Sarkoidosezentrum, Universitätsklinikum Würzburg, Würzburg, Deutschland.
| | - S Benoit
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland
- Zentrum für Seltene Erkrankungen (ZESE) Nordbayern - Sarkoidosezentrum, Universitätsklinikum Würzburg, Würzburg, Deutschland
| | - H Kneitz
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland
| | - M Goebeler
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland
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Chavarriaga-Restrepo A, López-Amaya JE, Mesa-Navas MA, Velásquez-Franco CJ. Sarcoidosis: muchas caras, una enfermedad. Revisión narrativa de la literatura. IATREIA 2019. [DOI: 10.17533/udea.iatreia.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
La sarcoidosis es una enfermedad granulomatosa sistémica de etiología desconocida. Esta puede afectar a pacientes de todas las latitudes y edades, siendo más frecuente entre la tercera y cuarta década de la vida con un segundo pico alrededor de los 50 años en las poblaciones escandinava y japonesa. Es más frecuente en mujeres y grave en la población afrodescendiente.Los antígenos que inician esta respuesta granulomatosa son desconocidos, pero se presume que son aerotransportados por la alta frecuencia de compromiso pulmonar en esta enfermedad. Su presentación clínica abarca una amplia gama de manifestaciones, desde formas agudas y limitadas hasta el compromiso crónico con daño orgánico progresivo y muerte. Su diagnóstico se basa en la existencia de los granulomas no caseificantes en los tejidos, con la exclusión de otras enfermedades, entre ellas infección por micobacterias.
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Knight L, Ngwanya M. Sarcoidosis of the scalp: the largest single-institutional case series. Int J Dermatol 2019; 58:e149-e151. [PMID: 31115900 DOI: 10.1111/ijd.14483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 04/08/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Lauren Knight
- Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Mzudumile Ngwanya
- Division of Dermatology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Periocular cutaneous sarcoid: case series and review of the literature. Eye (Lond) 2019; 33:1590-1595. [PMID: 31048763 DOI: 10.1038/s41433-019-0448-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 02/24/2019] [Accepted: 04/04/2019] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To illustrate the varying clinical presentations of cutaneous sarcoidosis affecting the periocular region, which may masquerade as other clinical entities such as basal cell carcinoma or seborrheic dermatitis. Furthermore, the authors present an unusual observation of lupus pernio involving the adnexal region with the rare presence of perineural granulomas on histology following incisional biopsy. METHODS We report a consecutive series of four cases with lesions involving the eyelids with varying clinical appearances. All four patients presented to our adnexal service undergoing incisional diagnostic biopsy. Histology following biopsy subsequently resulted in further investigation and management of both local cutaneous lesions and systemic sarcoidosis. RESULTS Three of our four cases had evidence of pulmonary involvement on chest X-ray. Over an 18-month period, one of two patients responded to intralesional triamcinolone and subsequently to oral methotrexate (15 mg/week). Two patients were observed with their periocular lesions remaining stable without therapy. CONCLUSIONS All four patients presented to the adnexal service with lesions of varying morphology and were diagnosed with sarcoidosis following incisional biopsy highlighting the vital role of oculoplastic surgeons in diagnosing this multisystem inflammatory disease. We describe our experience of intralesional triamcinolone, oral methotrexate and watchful observation in the management of such lesions.
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Tewari A, Natkunarajah J. Orange-red plaques in an older patient. BMJ 2019; 364:l2. [PMID: 30679165 DOI: 10.1136/bmj.l2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Angela Tewari
- Department of dermatology, Kingston Hospital, London, UK
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31
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Kobayashi M. Asymptomatic tiny subcutaneous eruptions in a patient with sarcoid neuropathy: the effectiveness of fluorine-18 fluorodeoxyglucose positron emission tomography for targeting safe biopsy sites. SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES 2019; 36:325-328. [PMID: 32476969 DOI: 10.36141/svdld.v36i4.8436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/19/2019] [Indexed: 11/02/2022]
Affiliation(s)
- Makoto Kobayashi
- Department of Neurology, Asahi General Hospital, Asahi, Chiba, Japan
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32
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Nguyen CTH, Kambe N, Ueda-Hayakawa I, Kishimoto I, Ly NTM, Mizuno K, Okamoto H. TARC expression in the circulation and cutaneous granulomas correlates with disease severity and indicates Th2-mediated progression in patients with sarcoidosis. Allergol Int 2018; 67:487-495. [PMID: 29598931 DOI: 10.1016/j.alit.2018.02.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 02/07/2018] [Accepted: 02/15/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Sarcoidosis is a systemic disorder characterized by the accumulation of lymphocytes and monocyte/macrophage lineage cells that results in the formation of non-caseating granulomas. Thymus- and activation-regulated chemokine (TARC)/CCL17 is an important chemokine in the amplification of Th2 responses, which are achieved by recruiting CCR4-expressing CD4+ T lymphocytes. TARC concentrations are known to increase in the serum of sarcoidosis patients; however, its role in the assessment of severity and prognosis of sarcoidosis remains unknown. The objective of this study is to elucidate the role of TARC in sarcoidosis by investigating its expression in peripheral blood and at inflammatory sites. We also examined its relationship with clinical features. METHODS Serum levels of TARC, soluble interleukin 2 receptor, angiotensin-converting enzyme, and lysozyme were measured in 82 sarcoidosis patients. The Th1 and Th2 balance in circulating CD4+ T cells was evaluated by flow cytometry. The immunohistochemical staining of TARC and CCR4 was performed in order to identify the source of TARC in affected skin tissues. RESULTS TARC serum levels were elevated in 78% of patients and correlated with disease severity. The percentage of CCR4+ cells and the CCR4+/CXCR3+ cell ratios were significantly higher in sarcoidosis patients than in normal subjects (P = 0.002 and P = 0.015, respectively). Moreover, TARC was expressed by monocyte/macrophage lineage cells within granulomas. The abundancy as well as distribution of TARC staining correlated with its serum levels. CONCLUSIONS The present results suggest that elevations in TARC drive an imbalanced Th2- weighted immune reaction and might facilitate prolonged inflammatory reactions in sarcoidosis.
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Affiliation(s)
- Chuyen Thi Hong Nguyen
- Department of Dermatology, Kansai Medical University, Osaka, Japan; Department of Dermatology and Venereology, University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam
| | - Naotomo Kambe
- Department of Dermatology, Kansai Medical University, Osaka, Japan; Allergy Center, Kansai Medical University, Osaka, Japan.
| | | | - Izumi Kishimoto
- Department of Dermatology, Kansai Medical University, Osaka, Japan; Allergy Center, Kansai Medical University, Osaka, Japan
| | - Nhung Thi My Ly
- Department of Dermatology, Kansai Medical University, Osaka, Japan
| | - Kana Mizuno
- Department of Dermatology, Kansai Medical University, Osaka, Japan
| | - Hiroyuki Okamoto
- Department of Dermatology, Kansai Medical University, Osaka, Japan
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Terziroli Beretta-Piccoli B, Mainetti C, Peeters MA, Laffitte E. Cutaneous Granulomatosis: a Comprehensive Review. Clin Rev Allergy Immunol 2018; 54:131-146. [PMID: 29352388 DOI: 10.1007/s12016-017-8666-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Cutaneous granulomatosis is a heterogeneous group of diseases, characterized by a skin inflammatory reaction triggered by a wide variety of stimuli, including infections, foreign bodies, malignancy, metabolites, and chemicals. From a pathogenic point of view, they are divided into non-infectious and infectious granulomas. Pathophysiological mechanisms are still poorly understood. Non-infectious granulomatous skin diseases include granuloma annulare, necrobiosis lipoidica, rheumatic nodules, foreign body granulomas, cutaneous sarcoidosis, and interstitial granulomatous dermatitis. Necrobiosis lipoidica is more frequent in diabetic patients. Infectious granulomas of the skin are caused by mycobacteria, in particular Mycobacterium tuberculosis or atypical mycobacteria; parasites, such as Leishmania; or fungi. Pathogenic mechanisms of M. tuberculosis-related granuloma are discussed. From a clinical point of view, it is useful to divide cutaneous granulomatosis into localized and more disseminated forms, although this distinction can be sometimes artificial. Three types of localized granulomatous lesions can be distinguished: palisaded granulomas (granuloma annulare, necrobiosis lipoidica, and rheumatoid nodules), foreign body granulomas, and infectious granulomas, which are generally associated with localized infections. Disseminated cutaneous granulomas can be divided into infectious, in particular tuberculosis, and non-infectious forms, among which sarcoidosis and interstitial granulomatous dermatitis. From a histological point of view, the common denominator is the presence of a granulomatous inflammatory infiltrate in the dermis and/or hypodermis; this infiltrate is mainly composed of macrophages grouped into nodules having a nodular, palisaded or interstitial architecture. Finally, we propose which diagnostic procedure should be performed when facing a patient with a suspected cutaneous granulomatosis.
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Affiliation(s)
| | - Carlo Mainetti
- Department of Dermatology, Bellinzona Regional Hospital, Bellinzona, Switzerland
| | | | - Emmanuel Laffitte
- Clinique de Dermatologie, Hôpitaux Universitaires de Genève, Rue Gabrielle Perret-Gentil 4, CH-1211, Genève, Switzerland.
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34
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Bhattacharjee R, Chatterjee D, De D. A Man With Infiltrated Plaques on the Pretibial Area. JAMA Dermatol 2018; 154:955-956. [PMID: 29710285 DOI: 10.1001/jamadermatol.2017.6449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Rajsmita Bhattacharjee
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology, and Leprology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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35
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Colboc H, Moguelet P, Bazin D, Bachmeyer C, Frochot V, Weil R, Letavernier E, Jouanneau C, Daudon M, Bernaudin J. Physicochemical characterization of inorganic deposits associated with granulomas in cutaneous sarcoidosis. J Eur Acad Dermatol Venereol 2018; 33:198-203. [DOI: 10.1111/jdv.15167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 06/18/2018] [Indexed: 12/26/2022]
Affiliation(s)
- H. Colboc
- Dermatologie Hôpital Rothschild, AP‐HP Paris France
- Sorbonne Université, UPMC Université Paris 06 Paris France
| | - P. Moguelet
- Anatomie et Cytologie Pathologiques Hôpital Tenon, AP‐HP Paris France
| | - D. Bazin
- Laboratoire de Chimie de la Matière Condensée de Paris Collège de France CNRS Sorbonne Université, UPMC Université Paris 06 Paris France
- CNRS, LPS, Ba510 Université Paris XI Orsay France
| | - C. Bachmeyer
- Médecine Interne Hôpital Tenon, AP‐HP Paris France
| | - V. Frochot
- UMR S 1155 Sorbonne Université, UPMC Université Paris 06 Paris France
- Explorations Fonctionnelles Multidisciplinaires Hôpital Tenon, AP‐HP Paris France
| | - R. Weil
- CNRS, LPS, Ba510 Université Paris XI Orsay France
| | - E. Letavernier
- UMR S 1155 Sorbonne Université, UPMC Université Paris 06 Paris France
- Explorations Fonctionnelles Multidisciplinaires Hôpital Tenon, AP‐HP Paris France
| | - C. Jouanneau
- Explorations Fonctionnelles Multidisciplinaires Hôpital Tenon, AP‐HP Paris France
| | - M. Daudon
- UMR S 1155 Sorbonne Université, UPMC Université Paris 06 Paris France
- Explorations Fonctionnelles Multidisciplinaires Hôpital Tenon, AP‐HP Paris France
| | - J.F. Bernaudin
- Sorbonne Université, UPMC Université Paris 06 Paris France
- Pneumologie Hôpital Avicenne APHP et EA2363 Université Paris 13 Bobigny France
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Atypical Cutaneous Presentations of Sarcoidosis: Two Case Reports and Review of the Literature. Curr Allergy Asthma Rep 2018; 18:40. [PMID: 29904803 DOI: 10.1007/s11882-018-0794-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The goal of this review is to provide the reader with an updated summary of the cutaneous manifestations of systemic sarcoidosis, with a particular emphasis on the predilection of sarcoidosis for scars, tattoos, and other areas of traumatized skin. RECENT FINDINGS While the mechanism underlying the propensity for traumatized skin to develop sarcoidosis lesions remains unclear, several theories have been proposed including the idea that cutaneous sarcoidosis represents an exuberant, antigen-driven foreign-body response, as well as the theory that traumatized skin represents an immunocompromised district with altered local immune trafficking and neural signaling. In this review, we present two cases in which the development of cutaneous lesions in scars and tattoos was integral to the diagnosis of systemic sarcoidosis. We then review the various cutaneous manifestations of systemic sarcoidosis, the clinical characteristics and differential diagnosis of scar and tattoo sarcoidosis, the proposed mechanism by which traumatized skin is prone to developing sarcoidosis lesions, and current treatments for cutaneous sarcoidosis.
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37
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Yamauchi K, Oiso N, Iwanaga T, Tatsumi Y, Matsumura I, Tohda Y, Kawada A. Post-herpes zoster sarcoidosis as a recurrence. J Dermatol 2018; 45:e150-e151. [PMID: 29318641 DOI: 10.1111/1346-8138.14211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kohei Yamauchi
- Department of Dermatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Naoki Oiso
- Department of Dermatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Takashi Iwanaga
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yoichi Tatsumi
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Itaru Matsumura
- Department of Hematology and Rheumatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Akira Kawada
- Department of Dermatology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
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38
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Cembrero Saralegui H, Imbernón Moya A, Churruca Grijelmo M. Three-dimensional eyebrows. JAAD Case Rep 2018; 4:7-9. [PMID: 29387744 PMCID: PMC5771720 DOI: 10.1016/j.jdcr.2016.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hirune Cembrero Saralegui
- Correspondence to: Hirune Cembrero Saralegui, MD, General Diaz Porlier 21, 7B, Madrid, Spain.General Diaz Porlier 21, 7BMadridSpain
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39
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Deng Q, Ding S, Yang S, Huang J. Cutaneous sarcoidosis and secondary open-angle glaucoma in a patient: case report and literature review. An Bras Dermatol 2017; 92:407-409. [PMID: 29186261 PMCID: PMC5514589 DOI: 10.1590/abd1806-4841.20175368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/02/2016] [Indexed: 12/29/2022] Open
Abstract
The current report presents the case of a 41-year-old male patient with a two-month history of asthenopia and plaques in the frontotemporal region. Computed tomography revealed bilateral hilar and mediastinal lymphadenopathy. Ophthalmological examination showed elevated intraocular pressure. Skin biopsy demonstrated aa dermal inflammatory infiltrate composed mainly of epithelioid cells and a few multinucleated giant cells, but no obvious lymphocytes. Findings of thorough physical examinations and auxiliary examinations suggested the presence of cutaneous sarcoidosis and secondary open-angle glaucoma. Treatment consisted mainly of oral methylprednisolone. Skin lesions, bilateral hilar, and mediastinal lymphadenopathy resolved completely. Cutaneous sarcoidosis is often accompanied by extracutaneous organ involvement. Dermatologists must be aware of the disease's extracutaneous manifestations to ensure accurate diagnosis for further treatments.
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Affiliation(s)
- Qiancheng Deng
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shu Ding
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Shengbo Yang
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, China
| | - JinHua Huang
- Department of Dermatology, Third Xiangya Hospital, Central South University, Changsha, China
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40
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Kilby KA, Kilbourne CM, Judson MA, Bonville DJ, Beegle SH. Considerations regarding sarcoidosis in the bariatric surgical patient. Surg Obes Relat Dis 2017; 14:219-224. [PMID: 29150393 DOI: 10.1016/j.soard.2017.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 09/29/2017] [Accepted: 10/08/2017] [Indexed: 11/29/2022]
Abstract
The sarcoidosis patient who seeks surgical management for obesity presents many challenges. The interaction between sarcoidosis and obesity complicates both disorders and creates special issues to consider when contemplating surgery. This manuscript will review the approach to pre- and postoperative management of the sarcoidosis patient undergoing bariatric surgery.
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Affiliation(s)
- Kimberly A Kilby
- Department of Surgery, Department of Family Medicine, Albany Medical College, Albany, New York.
| | - Colleen M Kilbourne
- Department of Surgery, Department of Family Medicine, Albany Medical College, Albany, New York
| | - Marc A Judson
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Albany Medical College, Albany, New York
| | - Daniel J Bonville
- Division of Acute Care Surgery and Surgical Critical Care, Department of Surgery, The Houston Methodist Hospital, Houston, Texas
| | - Scott H Beegle
- Department of Medicine, Division of Pulmonary & Critical Care Medicine, Albany Medical College, Albany, New York
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41
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42
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LaRosa C, Chiaravalloti A, Jinna S, Berger W, Finch J. Laser treatment of medical skin disease in women. Int J Womens Dermatol 2017; 3:131-139. [PMID: 28831422 PMCID: PMC5555278 DOI: 10.1016/j.ijwd.2017.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 05/09/2017] [Accepted: 05/09/2017] [Indexed: 01/01/2023] Open
Abstract
Laser treatment is a relatively new and increasingly popular modality for the treatment of many dermatologic conditions. A number of conditions that predominantly occur in women and that have a paucity of effective treatments include rosacea, connective tissue disease, melasma, nevus of Ota, lichen sclerosus (LS), notalgia paresthetica and macular amyloidosis, and syringomas. Laser therapy is an important option for the treatment of patients with these conditions. This article will review the body of literature that exists for the laser treatment of women with these medical conditions.
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Affiliation(s)
- C. LaRosa
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - A. Chiaravalloti
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - S. Jinna
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
| | - W. Berger
- Frank H. Netter MD School of Medicine, Quinnipiac University, North, Haven, CT
| | - J. Finch
- Department of Dermatology, University of Connecticut School of Medicine, Farmington, CT
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43
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Lakdawala N, Ferenczi K, Grant-Kels JM. Granulomatous diseases: Kids are not just little people. Clin Dermatol 2017; 35:555-565. [PMID: 29191347 DOI: 10.1016/j.clindermatol.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Granulomatous diseases represent a heterogeneous group of conditions characterized by histiocytic inflammation that affect patients of any age. These diseases differ widely in their pathogenesis and include infectious and noninfectious conditions. This review focuses on noninfectious granulomatous conditions, with particular emphasis on age-related differences in the onset, epidemiology, clinical manifestations, prognosis, and age-specific management of specific granulomatous disorders. Knowledge of age-specific aspects of granulomatous conditions in adults and children improves both the extent of the diagnostic workup and the management of these patients.
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Affiliation(s)
- Nikita Lakdawala
- Department of Dermatology, Medical College of Wisconsin, Milwuakee, WI.
| | - Katalin Ferenczi
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
| | - Jane M Grant-Kels
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT
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44
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AlQuorain NA, Yousef HA, AlJabre SH, AlAkloby OM, Al-Natour SH. Cosmetic lip tattoo sequelae: A case report and review of literature. JOURNAL OF DERMATOLOGY & DERMATOLOGIC SURGERY 2017. [DOI: 10.1016/j.jdds.2017.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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45
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Pereira EG, Guimarães TF, Bottino CB, D'Acri AM, Lima RB, Martins CJ. Sarcoidosis and chronic hepatitis C: treatment with prednisone and colchicine. An Bras Dermatol 2017; 91:231-4. [PMID: 27192527 PMCID: PMC4861575 DOI: 10.1590/abd1806-4841.20164029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Accepted: 10/16/2014] [Indexed: 01/15/2023] Open
Abstract
Sarcoidosis is a disease which still has uncertain etiology. Possible
environmental causes are cited in the literature, like organic and inorganic
particles and infectious agents. Recent studies have demonstrated the occurrence
of sarcoidosis in patients with chronic C hepatitis; however, this association
remains without statistical or causal evidence. In this report a case of
sarcoidosis associated with chronic hepatitis C will be described, with
subcutaneous lesions, considered rare, and good response to treatment with
colchicine and prednisone. The hepatitis C virus was isolated in sarcoid tissue
and the association between the two diseases will be discussed.
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Affiliation(s)
| | | | | | | | | | - Carlos José Martins
- Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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46
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47
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Thi Hong Nguyen C, Kambe N, Kishimoto I, Ueda-Hayakawa I, Okamoto H. Serum soluble interleukin-2 receptor level is more sensitive than angiotensin-converting enzyme or lysozyme for diagnosis of sarcoidosis and may be a marker of multiple organ involvement. J Dermatol 2017; 44:789-797. [DOI: 10.1111/1346-8138.13792] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 01/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - Naotomo Kambe
- Department of Dermatology; Kansai Medical University; Hirakata Japan
| | - Izumi Kishimoto
- Department of Dermatology; Kansai Medical University; Hirakata Japan
| | | | - Hiroyuki Okamoto
- Department of Dermatology; Kansai Medical University; Hirakata Japan
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48
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Valecha N, Bennett G, Yip L. A granulomatous conundrum: Concurrent necrobiosis lipoidica, cutaneous sarcoidosis and erythema nodosum in a nondiabetic patient. Australas J Dermatol 2017; 58:e232-e235. [DOI: 10.1111/ajd.12572] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 08/28/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Nishant Valecha
- Woden Dermatology; Canberra Australian Capital Territory Australia
| | - Genevieve Bennett
- Department of Pathology; Canberra Hospital; Canberra Australian Capital Territory Australia
| | - Leona Yip
- Australian National University Medical School; Canberra Australian Capital Territory Australia
- Dermatology; St Vincent's Hospital; Melbourne Victoria Australia
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49
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Zhao S, Wang Q, Cheng B, Zhu XF. Rare scar sarcoidosis: A case report. Exp Ther Med 2017; 13:1535-1537. [PMID: 28413505 DOI: 10.3892/etm.2017.4123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 12/01/2016] [Indexed: 11/06/2022] Open
Abstract
A 70-year-old female patient presenting with swelling and subcutaneous nodule formation localized to the knee scars over a two-month period is presently reported. Dermatological examinations found erythematous swelling and small papules on the patient's knee scars, along with subcutaneous nodules beneath and around the scars. Computer tomography of the chest region identified multiple obscure tubercles in the lungs and swollen lymph nodes in the hilum pulmonis and mediastinum. Skin biopsy revealed multiple non-caseating granulomas, which had infiltrated the dermis. The patient was diagnosed with scar sarcoidosis as a result of these observations. The onset of scar sarcoidosis is rare and, therefore, not well understood; however, inflammatory alterations in preexisting scars may be important indicators for disease onset.
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Affiliation(s)
- Sha Zhao
- Department of Dermatology, Clinical Medical School of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Qin Wang
- Department of Dermatology, Clinical Medical School of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Beibei Cheng
- Department of Dermatology, Clinical Medical School of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
| | - Xiao-Fang Zhu
- Department of Dermatology, Clinical Medical School of Yangzhou University, Yangzhou, Jiangsu 225001, P.R. China
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50
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Park SK, Hwang PH, Yun SK, Kim HU, Park J. Tumor Necrosis Factor Alpha Blocker-Induced Erythrodermic Sarcoidosis in with Juvenile Rheumatoid Arthritis: A Case Report and Review of the Literature. Ann Dermatol 2017; 29:74-78. [PMID: 28223750 PMCID: PMC5318531 DOI: 10.5021/ad.2017.29.1.74] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 06/23/2016] [Accepted: 06/25/2016] [Indexed: 01/23/2023] Open
Abstract
The development of cutaneous sarcoidosis as a paradoxical adverse event of tumor necrosis factor alpha (TNF-α) blockers has been reported in the literature; however, an erythrodermic form of cutaneous sarcoidosis during anti-TNF-α therapy has not yet been reported. Herein, we report the first case of an erythrodermic form of cutaneous sarcoidosis during anti-TNF-α therapy and review previous studies of cutaneous sarcoidosis. A 6-year-old Korean girl who had been suffering from juvenile rheumatoid arthritis presented with generalized erythematous skin eruption involving more than about 90% of her body surface area. After 14 months of etanercept treatment, the new erythematous skin eruption had developed and progressed into generalized erythroderma. Exclusion of suspected co-medication had been performed based on medication history. She had no other systemic symptoms, and ophthalmologic and neurologic examinations were normal. Histopathologic findings of the skin lesion revealed diffuse non-caseating granulomatous infiltrates composed of epithelioid histiocytes with sparse lymphocytes involving the entire dermis. Periodic-acid-Schiff and acid-fast stains were negative, and acid-fast bacilli was not detected by polymerase chain reaction of the skin biopsy. Based on clinicopathologic findings, she was diagnosed with etanercept-induced sarcoidal granuloma. After discontinuation of the suspected agent, the lesions spontaneously disappeared.
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Affiliation(s)
- Su-Kyung Park
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea
| | - Pyung-Han Hwang
- Department of Pediatrics, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Seok-Kweon Yun
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Han-Uk Kim
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jin Park
- Department of Dermatology, Chonbuk National University Medical School, Jeonju, Korea.; Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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