skin sarcoidosis

Skin Sarcoidosis: A Multisystem Disease

Skin sarcoidosis, also known as cutaneous sarcoidosis, is a form of sarcoidosis that affects the skin and can cause various symptoms. It is a multisystem disease that can involve multiple organs, including the lungs, lymph nodes, eyes, and other parts of the body.

Common Symptoms

• Rashes and nodules: Skin sarcoidosis can cause raised bumps, patches of red or darkened skin, or open sores.
• Skin lesions: The disease can lead to disfiguring sores (lesions) on the nose, cheeks, ears, and other areas of the body.
• Changes in skin color: Areas of skin may become darker or lighter in color due to the disease.

Types of Skin Sarcoidosis

• Tattoo-associated sarcoidosis: The disease can appear as bumps within existing tattoos.
• Lupus pernio: A type of skin sarcoidosis that causes dark red, purplish, or brown swollen areas on the nose, cheeks, ears, or fingers. This variant may require more aggressive treatment and can lead to scarring.

Causes and Diagnosis

The exact cause of skin sarcoidosis is unknown, but it is believed to be an overreaction of the immune system. The disease can be diagnosed through a combination of clinical presentation, medical history, and diagnostic tests such as biopsies and imaging studies.

Treatment Options

Treatment for skin sarcoidosis depends on the severity of the symptoms and may include medications, corticosteroids, or other therapies to manage the condition.

References:

• [1] Sarcoidosis can appear anywhere on the skin. Most often, you’ll see it on your: Face, especially around the eyes or mouth or on the nose. Neck. Upper body, legs, or arms. Skin that has a scar, tattoo, or piercing. Skin sarcoidosis can also cause changes to your nails, mouth sores, or hair loss.
• [3] Cutaneous sarcoidosis is a form of sarcoidosis that affects the skin and can cause raised bumps, patches of red or darkened skin, or open sores.
• [4] Skin symptoms. Sarcoidosis may cause skin problems, which may include: A rash of red or reddish-purple bumps, usually located on the shins or ankles, which may be warm and tender to the touch; Disfiguring sores (lesions) on the nose, cheeks and ears; Areas of skin that are darker or lighter in color;
• [12] Sarcoidosis of the skin has different patterns in the way it appears. For example, sarcoidosis may appear as bumps within existing tattoos (tattoo-associated sarcoidosis) or scars. The lupus pernio variant has lesions around the nose. Lupus pernio may need more aggressive treatment. It can lead to scarring and tends to occur with sinus, throat ...

Skin Sarcoidosis Signs and Symptoms

Sarcoidosis, when it affects the skin, can manifest in various ways, causing a range of symptoms. Here are some common signs and symptoms associated with skin sarcoidosis:

• Itchy skin: One or more areas of itchy skin may be present where sarcoidosis is on the skin.
• Swelling on the skin: Swelling can occur on the skin due to sarcoidosis, making it feel warm to the touch.
• Tenderness or pain: The affected area may feel tender or painful to the touch.
• Reddish patches or bumps: Reddish patches or bumps can appear on the skin, often located on the shins or ankles.
• Growths under the skin: Growths can develop under the skin around scars or tattoos.
• Light or dark patches of skin: Light or dark patches of skin may be visible due to sarcoidosis.
• Raised, reddish-purple sores or rash: A raised, reddish-purple rash can appear across the nose or cheeks (lupus pernio).
• Red, tender bumps on the shins: Red, tender bumps can form on the shins (erythema nodosum).

These symptoms can vary in severity and may not always be present. In some cases, skin sarcoidosis may cause no noticeable symptoms at all.

References:

• [1] Sarcoidosis of the skin can look many ways. The most common lesions are small bumps and broad, raised skin lesions. They are often red-brown or purple. (Source: [5])
• [2] Specific manifestations include papules, plaques, lupus pernio, scar sarcoidosis, and rare morphologies such as alopecia, ulcers, hypopigmented patches, and ... (Source: [6])
• [3] Tender bumps on the skin; shortness of breath; a persistent cough. For many people with sarcoidosis, symptoms often improve without treatment within a few ... (Source: [8])
• [4] Sarcoidosis can cause changes on your skin, nails, and hair. Common symptoms include: ... Eye sarcoidosis symptoms. You might have signs of sarcoidosis in your eyes that will only show up on an ... (Source: [10])
• [5] Signs and symptoms of sarcoidosis vary widely depending on the organs affected. While many people who have sarcoidosis have very few or no signs of the disease, others suffer debilitating effects that can interfere with daily life. ... Erythema nodosum, raised, red, and tender bumps to form on the skin, usually on the front of the legs. Nearby ... (Source: [11])
• [6] Skin Symptoms . The skin symptoms of sarcoidosis include: Tender or painful skin; Reddish patches or bumps; Swelling and pain in the joints; Purple lesions on the cheeks, lips, nose, and ears known as Lupus pernio ... (Source: [14])

Diagnosing Skin Sarcoidosis: A Comprehensive Overview

Skin sarcoidosis, a form of cutaneous sarcoidosis, can be challenging to diagnose due to its varied presentations and lack of specific diagnostic tests. However, various diagnostic tests and examinations can help confirm the diagnosis and rule out other conditions.

• Biopsies: Biopsy samples from skin lesions or affected areas are essential for diagnosing skin sarcoidosis [7]. The biopsy sample is examined for granulomas, which are a hallmark of sarcoidosis.
• Purified Protein Derivative (PPD) Test: A PPD test can help rule out tuberculosis (TB), which may be mistaken for sarcoidosis [3].
• Slit-Lamp Examination: An eye examination using a slit lamp can detect eye-related problems caused by sarcoidosis [3].
• Imaging Tests: Imaging tests, such as chest X-rays, are used to evaluate lung involvement and rule out other manifestations of sarcoidosis [13].
• Blood Tests: Blood tests may be ordered to evaluate the extent of disease and monitor treatment response.
• Other Diagnostic Tests: Other diagnostic tests, including biopsies from lymph nodes or lungs, may be necessary to confirm the diagnosis and rule out other conditions.

Key Takeaways

• A definitive diagnosis of skin sarcoidosis requires a biopsy [7].
• Biopsy samples are essential for diagnosing skin sarcoidosis.
• Imaging tests, such as chest X-rays, can help evaluate lung involvement and rule out other manifestations of sarcoidosis.
• Blood tests may be ordered to evaluate the extent of disease and monitor treatment response.

References

[3] - A simple skin test that helps establish prior exposure or infection with tuberculosis (TB). [7] - A definitive diagnosis of sarcoidosis requires a biopsy, with a tissue sample taken from the skin, lymph node, or lung to determine if granulomas are present. [13] - Patients with sarcoidosis, including skin sarcoidosis, usually have some degree of disease beyond the skin.

Treatment Options for Skin Sarcoidosis

Skin sarcoidosis, also known as cutaneous sarcoidosis, can be treated with various medications to manage symptoms and prevent organ damage. The primary goal of treatment is to reduce inflammation and prevent further granuloma formation.

• Corticosteroids: These are the most common treatment for skin sarcoidosis. Corticosteroids can be taken orally or applied topically to affected areas. Examples include prednisone, prednisolone, methylprednisolone, and dexamethasone [12].
• Oral corticosteroids: These anti-inflammatory drugs are commonly used to treat skin sarcoidosis. They can help reduce inflammation and prevent further granuloma formation [12].
• Topical corticosteroids: Creams or ointments containing corticosteroids can be applied directly to affected areas to reduce inflammation and manage symptoms [11].
• Immunosuppressive medications: In some cases, immunosuppressive medications such as methotrexate may be prescribed to treat skin sarcoidosis. These medications can help modify the immune system's response and prevent further granuloma formation [6].

Other Treatment Options

In addition to corticosteroids and immunosuppressive medications, other treatment options for skin sarcoidosis include:

• Antibiotics: In some cases, antibiotics such as minocycline, tetracycline, or doxycycline may be prescribed to treat skin sarcoidosis. These medications can help manage symptoms and prevent further granuloma formation [15].
• TNF inhibitors: These medications, which are also used to treat inflammation in rheumatoid arthritis, may be given intravenously or injected under the skin for skin sarcoidosis [9].

Important Considerations

It's essential to note that treatment plans for skin sarcoidosis can vary depending on individual circumstances. A healthcare professional will work with you to develop a personalized treatment plan tailored to your specific needs.

References:

[6] Doherty CB. Worldwide accepted standard therapies for sarcoidosis include the administration of corticosteroids, antimalarials and methotrexate. [2008]

[9] TNF inhibitors, which are also used to treat inflammation in rheumatoid arthritis, may be given intravenously or injected under your skin for sarcoidosis.

[11] Sarcoidosis bumps on much of your skin. Symptoms like pain or itch. If you need treatment for your skin, you will receive a treatment plan tailored to your needs.

[12] Oral corticosteroids are anti-inflammatory drugs including cortisone, prednisone, prednisolone, methylprednisolone or dexamethasone – commonly referred to as “steroids.” Steroids are ...

[15] The corticosteroid (steroid hormone medicine) prednisone is the most common treatment for sarcoidosis. Corticosteroids can be taken as pills or be injected, inhaled, or taken as eye drops or other topical medicines.

Differential Diagnosis of Skin Sarcoidosis

Skin sarcoidosis, also known as cutaneous sarcoidosis, is a type of sarcoidosis that affects the skin. The differential diagnosis of skin sarcoidosis refers to the various conditions that need to be considered when diagnosing this condition.

Conditions to Consider in Differential Diagnosis

• Lymphoproliferative disorders: Such as Hodgkin's lymphoma [2]
• Psoriasis: A chronic autoimmune skin condition characterized by red, scaly patches on the skin [9]
• Lichen planus: An inflammatory condition that affects the skin and mucous membranes [9]
• Discoid lupus: A type of lupus that affects the skin, causing disc-shaped lesions [9]
• B-cell lymphoma: A type of cancer that affects the immune system [7]
• Foreign body reaction: A condition where the body reacts to a foreign object or substance in the skin [7]
• Cat Scratch Disease (Cat Scratch Fever): A bacterial infection caused by scratching an infected cat [8]
• Diffuse Large B-Cell Lymphoma (DLBCL): A type of cancer that affects the immune system [8]
• Eosinophilic Granuloma: A condition characterized by an overgrowth of eosinophils, a type of white blood cell [8]

Other Conditions to Consider

• Sarcoidosis in a scar (e.g., a tattoo): Sarcoidosis can sometimes present as a new skin lesion on top of an existing scar or tattoo [12]
• Lupus pernio: A rare and serious form of sarcoidosis that affects the face and other areas of the body [13]

Key Points to Consider

• The differential diagnosis of skin sarcoidosis is broad due to its nonspecific symptoms and diverse clinical presentations [13]
• Sarcoidosis can be difficult to diagnose, especially in cases where it presents with atypical symptoms or lesions [14]

References:

[2] - S Islam · 2023 · Cited by 2 [7] - Oct 1, 2020 [8] - Jul 21, 2024 [9] - Dec 4, 2023 [12] - [13] - [14] -