Cutaneous Sarcoidosis: A Retrospective Clinico-Pathological Study from the Indian Subcontinent in Patients Attending a Tertiary Health Care Centre

A Rare Skin Lesion Presentation With Sarcoidosis

Sarcoidosis is a multifaceted systemic disease of uncertain aetiology, pathologically characterised by non-caseating granulomas. Typical symptoms include coughing, dyspnoea, chest pain and lesions affecting the eyes or skin. Cutaneous sarcoidosis frequently accompanies the involvement of other organs, but isolated cutaneous presentations are also observed. We present a case of cutaneous sarcoidosis in a 31-year-old Indian male. The diagnosis of sarcoidosis was confirmed by a skin biopsy, which showed that there is a naked, non-caseating granuloma filling the upper and deep dermis, formed of epithelioid histiocytes and multinucleated giant cells. Treatment with the intralesional steroid triamcinolone acetonide (5 mg/mL) monthly is considered. We hope to raise doctors' awareness of the various forms of sarcoidosis, consequently improving diagnostic skills and patient treatment.

Microneedling-associated facial skin changes

A 28-year-old Afro-Caribbean woman underwent a second facial microneedling procedure to improve skin texture. A skin cleanser was applied pretreatment. The next day she had a sensation of irritation and tingling in the treated areas and within 3 days had developed red inflamed nodules on both cheeks.

Cutaneous Sarcoidosis: A Differential Diagnosis to Consider in Undiagnosed Skin Lesions

The presentation of sarcoidosis varies depending on the organs involved. Cutaneous sarcoidosis usually presents with other organ involvement, but isolated presentation is possible. However, diagnosing isolated cutaneous sarcoidosis can be challenging in resource-poor countries, particularly where sarcoidosis is relatively uncommon, since cutaneous sarcoidosis usually does not cause troublesome symptoms. We present a case of cutaneous sarcoidosis in an elderly female who had been suffering from skin lesions for nine years. The diagnosis was made after the appearance of lung involvement, which raised the suspicion of sarcoidosis and prompted a skin biopsy. The patient was then treated with systemic steroids and methotrexate, and her lesions improved shortly thereafter. This case highlights the importance of considering sarcoidosis as a possible cause of undiagnosed, refractory cutaneous lesions.

Evaluation of clinical and laboratory characteristics of patients with cutaneous sarcoidosis: A single-center retrospective cohort study

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.