Sarcoidosis

Sarcoidosis is a systemic granulomatous disease of unknown etiology that most often involves the lungs (90%). The skin is involved in about one third of patients with systemic sar-coidosis. In the United States, women and African Americans are more frequently affected. As with syphilis, sarcoidosis is considered a "great imitator" because it has widely variable presentations and may involve almost any organ system.

Classic skin lesions of sarcoidosis are red-brown, nonscaly papules and plaques appearing on the face, especially around the nose or mouth (Fig. 33-73). Color can vary significantly from yellow to red to brown, and lesions also occur on the trunk or extremities and tend to be symmetric. Lesions on the alar rim of the nose, also known as lupus pernio, are highly

Figure 33-72 Heliotrope rash of dermatomyositis. ©J Richard P. Usatine.) Figure 33-73 Cutaneous sarcoidosis. © Richard P. Usatine.)

associated with granulomatous infiltration of the upper airway. Patients with cutaneous sarcoidosis should have a complete evaluation for systemic disease, including history and physical examination, renal and hepatic function testing, chest radiograph, pulmonary function tests, electrocardiog-raphy, and ophthalmologic evaluation.

Lesions of cutaneous sarcoidosis are difficult to treat and tend to recur. The most effective therapy is intralesional injection of corticosteroids repeated at 2- to 4-week intervals. Topical corticosteroids are often ineffective because they do not penetrate the skin lesions adequately. Systemic cortico-steroids are effective in treating lesions that are widespread or impairing function. In especially difficult cases, agents such as hydroxychloroquine or methotrexate may be used.

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