• 17

Sarcoidosis is a disease characterized by the growth of tiny collections of inflammatory cells (granulomas) in any part of your body — most commonly the lungs and lymph nodes. But it can also affect the eyes, skin, heart and other organs.

The cause of sarcoidosis is unknown, but experts think it results from the body’s immune system responding to an unknown substance. Some research suggests that infectious agents, chemicals, dust and a potential abnormal reaction to the body’s own proteins (self-proteins) could be responsible for the formation of granulomas in people who are genetically predisposed.

Cutaneous features 

Approximately 20-35% of patients with systemic sarcoidosis have skin lesions, but cutaneous sarcoidosis can occur without systemic involvement. Cutaneous sarcoid is one of the great mimickers as it has a wide range of morphological features.

  • Lupus pernio
    • ​Large bluish-red-purple infiltrated nodules and plaques
    • The most commonly affected sites are a roughly symmetrical involvement of the nose, cheeks, and ears. The hands, fingers and toes can also be affected
    • Nasal involvement is associated with oedema, crusting, or ulceration of the nasal vestibule, which can affect breathing
    • Lesions can be chronic and systemic involvement is common

  • Maculopapular
    • Maculopapular sarcoidosis is the most common cutaneous finding, especially in black women
    • Usually, lesions are asymptomatic, red-brown macules and papules commonly involving the face, especially the periorbital areas and the nasolabial folds, and/or the extensor surfaces
    • Lesions usually resolve without scarring

       

  • Papules and nodules
    • Lesions can be red-yellow or purple-brown
    • Papules – can be few or very many. Lesions arise in crops, mainly on the face and extensor aspects of the limbs. They generally carry a more favourable prognosis
    • Nodules – are solitary or few. Lesions mainly affect the proximal limbs, trunk and face

  • Plaques
    • The limbs and buttocks are the most commonly affected sites
    • Lesions are red-purple-brown, diffuse, and can grow to many cm in diameter

  • Annular
    • Annular lesions are most common on the face and neck, although other sites can be affected
    • Lesions have peripheral evolution and central clearing

  • Scar sarcoidosis 
    • Sarcoid can cause thickening of old scars, which become red-purple-brown
    • This may be the only cutaneous feature
    • Sarcoid has also been seen in tattoos
  • Erythema nodosum
    • Mainly affects young women in patients with sarcoidosis
    • Is often associated with hilar lymphadenopathy, uveitis, and usually a good prognosis, with most cases resolving within two years

Sarcoidosis has many other cutaneous presentations including alopecia, hypopigmentation, and ichthyosiform sarcoidosis. It has also been associated with vasculitis, and necrobiosis lipoidica
Sarcoidosis can also affect lungs , eyes, heart, calcium metabolism, the nervous system, the liver and spleen, muscles, bones and joints, the kidneys, lymph nodes, or any other organ.

When to see a doctor

See your doctor if you have signs and symptoms of sarcoidosis.

Diagnosis

Your doctor may order a small sample of tissue (biopsy) be taken from a part of your body believed to be affected by sarcoidosis to look for the granulomas commonly seen with the condition. For example, biopsies can be taken from your skin if you have skin lesions and from the lungs and lymph nodes if needed.

Treatment

There’s no cure for sarcoidosis, but in many cases, it goes away on its own. You may not even need treatment if you have no symptoms or only mild symptoms of the condition. The severity and extent of your condition will determine whether and what type of treatment is needed.

If your symptoms are severe or organ function is threatened, you will likely be treated with medications. These may include:

  • Corticosteroids. These powerful anti-inflammatory drugs are usually the first line treatment for sarcoidosis. In some cases, corticosteroids can be applied directly to an affected area — via a cream to a skin lesion or drops to the eyes.
  • Medications that suppress the immune system. Medications such as methotrexate (Trexall) and azathioprine (Azasan, Imuran) reduce inflammation by suppressing the immune system.
  • Hydroxychloroquine. May be helpful for skin lesions and elevated blood-calcium levels.
  • Tumor necrosis factor-alpha (TNF-alpha) inhibitors. These medications are commonly used to treat the inflammation associated with rheumatoid arthritis. They can also be helpful in treating sarcoidosis that hasn’t responded to other treatments.

Depending on your symptoms or complications, other treatments may be recommended. For example, you may have physical therapy to reduce fatigue and improve muscle strength, pulmonary rehabilitation to decrease respiratory symptoms, or an implanted cardiac pacemaker or defibrillator for heart arrhythmias.

Organ transplant may be considered if sarcoidosis has severely damaged your lungs, heart or liver.

 

 

Call Now Button