Background

Dermatologic manifestations are seen in 25% of patients with sarcoidosis. They usually accompany systemic involvement, but in some cases they may be the only manifestations of the disease. Sarcoidosis is characterized by noncaseating epithelioid granulomas that may affect any organ system.^[1]

Although Jonathan Hutchinson described the first case in 1869, the etiology of the disease is still unknown. The disease most commonly involves granuloma formation in the lungs, with 90-95% of patients having some pulmonary involvement. Other commonly involved organ systems include the lymph nodes (especially the intrathoracic nodes), the skin, the eyes, the liver, the heart, and the nervous, musculoskeletal, renal, and endocrine systems.^[2]

Clinical Presentation

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Jorizzo JL, Koufman JA, Thompson JN, White WL, Shar GG, Schreiner DJ. Sarcoidosis of the upper respiratory tract in patients with nasal rim lesions: a pilot study. J Am Acad Dermatol. 1990 Mar. 22(3):439-43. [QxMD MEDLINE Link].
Marcoval J, Maña J, Moreno A, Peyri J. Subcutaneous sarcoidosis--clinicopathological study of 10 cases. Br J Dermatol. 2005 Oct. 153(4):790-4. [QxMD MEDLINE Link].
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Antonovich DD, Callen JP. Development of sarcoidosis in cosmetic tattoos. Arch Dermatol. 2005 Jul. 141(7):869-72. [QxMD MEDLINE Link].
Dimitriou F, Frauchiger AL, Urosevic-Maiwald M, Naegeli MC, Goldinger SM, Barysch M, et al. Sarcoid-like reactions in patients receiving modern melanoma treatment. Melanoma Res. 2018 Jun. 28 (3):230-236. [QxMD MEDLINE Link].
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Jones E, Callen JP. Hydroxychloroquine is effective therapy for control of cutaneous sarcoidal granulomas. J Am Acad Dermatol. 1990 Sep. 23(3 Pt 1):487-9. [QxMD MEDLINE Link].
Pariser RJ, Paul J, Hirano S, Torosky C, Smith M. A double-blind, randomized, placebo-controlled trial of adalimumab in the treatment of cutaneous sarcoidosis. J Am Acad Dermatol. 2013 May. 68(5):765-73. [QxMD MEDLINE Link].
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Carlesimo M, Giustini S, Rossi A, Bonaccorsi P, Calvieri S. Treatment of cutaneous and pulmonary sarcoidosis with thalidomide. J Am Acad Dermatol. 1995 May. 32(5 Pt 2):866-9. [QxMD MEDLINE Link].
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Kataria YP. Chlorambucil in sarcoidosis. Chest. 1980 Jul. 78(1):36-43. [QxMD MEDLINE Link].
Waldinger TP, Ellis CN, Quint K, Voorhees JJ. Treatment of cutaneous sarcoidosis with isotretinoin. Arch Dermatol. 1983 Dec. 119(12):1003-5. [QxMD MEDLINE Link].
Brechtel B, Haas N, Henz BM, Kolde G. Allopurinol: a therapeutic alternative for disseminated cutaneous sarcoidosis. Br J Dermatol. 1996 Aug. 135(2):307-9. [QxMD MEDLINE Link].
Inoue Y, Teraki Y. Association of Propionibacterium acnes with the efficacy of minocycline therapy for cutaneous sarcoidosis. Int J Dermatol. 2020 Jun. 59 (6):704-708. [QxMD MEDLINE Link].
Bachelez H, Senet P, Cadranel J, Kaoukhov A, Dubertret L. The use of tetracyclines for the treatment of sarcoidosis. Arch Dermatol. 2001 Jan. 137(1):69-73. [QxMD MEDLINE Link].
Baughman RP, Judson MA, Lower EE, Drent M, Costabel U, Flavin S, et al. Infliximab for chronic cutaneous sarcoidosis: a subset analysis from a double-blind randomized clinical trial. Sarcoidosis Vasc Diffuse Lung Dis. 2016 Jan 15. 32 (4):289-95. [QxMD MEDLINE Link].
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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 May - Jun. 95 (3):340-342. [QxMD MEDLINE Link].
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Media Gallery

Erythema nodosum.
Bilateral hilar lymphadenopathy.
Stage III pulmonary disease with pulmonary infiltrates.
Periocular papules and plaques.
Plaque sarcoidosis.
Erythematous papules on the knee.
Lupus pernio with nodules on the nasal tip and sidewall.
Annular sarcoidosis.
Sarcoidosis with infiltration of a scar.
Histopathologic features of sarcoidosis showing the hallmark noncaseating granulomas.
Cutaneous sarcoidosis. Violaceous papules or nodules of lupus pernio.

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#author-disclosures{display:block}#author-disclosures.modal-layer{position:relative}#author-disclosures .modal-content{max-height:none}#author-disclosures .close-modal{display:none}

Author

Joseph F Merola, MD, MMSc Professor and Chair Member, Department of Dermatology; Professor, Department of Internal Medicine, Division of Rheumatic Diseases, Peter O’Donnell Jr School of Public Health at UT Southwestern Medical Center

Joseph F Merola, MD, MMSc is a member of the following medical societies: American Academy of Dermatology, American College of Rheumatology, American Dermatological Association, Association of Program Directors in Internal Medicine, Group for Research and Assessment of Psoriasis and Psoriatic Arthritis, Medical Dermatology Society, National Psoriasis Foundation, Massachusetts Medical Society, Noah Worcester Dermatological Society, Rheumatologic Dermatology Society, Society for Investigative Dermatology

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Consultant and/or investigator for Merck, Abbvie, Dermavant, Eli Lilly, Novartis, Janssen, UCB, Celgene, Sanofi, Regeneron, Arena, Sun Pharma, Biogen, Pfizer, EMD Sorono, Avotres and Leo Pharma.

Coauthor(s)

Jeffrey P Callen, MD Professor of Medicine (Dermatology), Chief, Division of Dermatology, University of Louisville School of Medicine

Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, American College of Rheumatology

Disclosure: Received income in an amount equal to or greater than $250 from: Biogen US (Adjudicator for study entry cutaneous lupus erythematosus); Priovant (Adjudicator for entry into a dermatomyositis study); IQVIA (Serono - adjudicator for a study of cutaneous LE) <br/>Received honoraria from UpToDate for author/editor; Received royalty from Elsevier for book author/editor; Received dividends from trust accounts, but I do not control these accounts, and have directed our managers to divest pharmaceutical stocks as is fiscally prudent from Stock holdings in various trust accounts include some pharmaceutical companies and device makers for these trust accounts for: Stocks held in various trust accounts: Allergen; Amgen; Pfizer; 3M; Johnson and Johnson; Merck; Abbott Laboratories; AbbVie; Procter and Gamble;; Celgene; Gilead; CVS; Walgreens; Bristol-Myers Squibb.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Ponciano D Cruz, Jr, MD Professor and Vice-Chair, Paul R Bergstresser Chair, Department of Dermatology, University of Texas Southwestern Medical Center

Ponciano D Cruz, Jr, MD is a member of the following medical societies: Texas Medical Association

Disclosure: Received consulting fee from RCTS for independent contractor; Received honoraria from Mary Kay Cosmetics for consulting; Received grant/research funds from Galderma for principal investigator.

Acknowledgements

Karen Podlipsky Gould, MD Physician, Private Practice

Karen Podlipsky Gould, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

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