Author: Dr Stanley Leong, Dermatology and Paediatric Registrar, New Zealand, 2024
Reviewing dermatologist: Dr Ian Coulson (2024).
Edited by the DermNet content department
This 30-year-old woman presented with an erythematous rash on her back and thighs. The lesions started a year ago, and were not itchy or tender. More lesions were developing over time.
She had no previous history of skin disorders, and no known family history of skin disorders or autoimmune disease.
On examination, she had multiple dark red plaques with a rim of brownish hues over the back, buttock, thighs, and lower legs. They were mildly indurated on palpation. She did not have lymphadenopathy or organomegaly.
Histology showed non-caseating granulomatous inflammation. Tissue culture was negative.
Her serum angiotensin-converting enzyme (ACE) level was very high. Her chest x-ray showed multiple nodules.
This is cutaneous sarcoidosis, confirmed on histology. The diagnosis is also supported by the elevated ACE level, and the pulmonary nodules on chest x-ray.
Sarcoidosis is a multisystem disease, characterised by granulomas in various organs. It can affect various organs such as the lungs, skin, eyes, liver, and heart, and both the central nervous system and musculoskeletal system.
Local corticosteroids (topical or intralesional) are the first-line therapy. Ultrapotent topical steroids are usually required.
Oral prednisone can be used for extensive cutaneous sarcoidosis. Patients with pulmonary sarcoidosis will usually require systemic (oral) steroids for lung inflammation.
Oral hydroxychloroquine is effective for cutaneous sarcoidosis as a steroid-sparing option. Patients should be counselled about the potential retinal and renal toxicity associated with oral hydroxychloroquine. Patients should have regular ophthalmology screening if they are on long-term oral hydroxychloroquine.
Other therapies such as methotrexate and biological treatments are sometimes considered for refractory disease.
See: Sarcoidosis
