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Cutaneous Sarcoidosis: The ‘Great Imitator’

Etiopathogenesis, Morphology, Differential Diagnosis, and Clinical Management

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Abstract

Sarcoidosis is a multisystem disease that can involve almost any organ system. The underlying cause of the disease remains unknown. Immunopathologically and histologically, cutaneous sarcoidosis is characterized by a macrophage/T helper-1 cell-mediated, non-caseating, granulomatous inflammation process. An imbalance between proinflammatory and anti-inflammatory cytokines plays an important role in the development of cutaneous granulomas. Recognition of cutaneous sarcoidosis lesions is very important because they provide a visible clue to the diagnosis and are an easily accessible source of tissue for histologic examination. Because skin lesions of patients with the disease can exhibit many different morphologies, cutaneous sarcoidosis is known as one of the ‘great imitators’ in dermatology. Specific manifestations can include patches (sometimes hypopigmented), papules, scar sarcoidosis, ulcers, ichthyosis, and alopecia. The treatment of cutaneous sarcoidosis is often frustrating because some of the skin lesions may be refractory to treatment or may recur following successful treatment. Systemic and topical corticosteroids are the most effective treatments for cutaneous sarcoidosis.

This article focuses on the dermatologic aspects of sarcoidosis and includes a review of the most recent literature, which includes new data on the diagnosis, differential diagnosis, pathogenesis, and treatment of the disease.

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References

  1. Reich JM. What is sarcoidosis? Chest 2003; 124 (1): 367-71

    Article  PubMed  Google Scholar 

  2. Thomas KW, Hunninghake GW. Sarcoidosis. JAMA 2003; 289 (24): 3300-3

    Article  PubMed  Google Scholar 

  3. Grutters JC, van den Bosch JM. Corticosteroid treatment in sarcoidosis. Fur Respir 12006; 28 (3): 627-36

  4. Lee JB, Koblenzer PS. Disfiguring cutaneous manifestation of sarcoidosis treated with thalidomode: a case report. J Am Acad Dermatol 1998; 39 (5 Pt 2): 835-8

    Article  PubMed  CAS  Google Scholar 

  5. Zabel P, Entzian P, Dalhoff K, et al. Pentoxifylline in treatment of sarcoidosis. Am

  6. J Respir Crit Care Med 1997; 155: 1665-9

  7. Baughman RP, Lower EE, du Bois EM. Sarcoidosis. Lancet 2003; 361: 1111-8

    Article  PubMed  CAS  Google Scholar 

  8. Braun-Falco O, Plewig G, Wolf HH. Granulomatése Erkrankungen unbekannter Ursache. In: Smolle J, Kerl H. Dermatologie and venerologie. 4th ed. Berlin: Walter de Gruyter, 1997: 1231-8

    Google Scholar 

  9. Djuric B. Sarcoidosis in Eastern Europe. Sarcoidosis 1985; 2 (1): 35-7

    PubMed  CAS  Google Scholar 

  10. Milman N, Selroos O. Pulmonary sarcoidosis in the Nordic countries 1950-1982: epidemiology and clinical picture. Sarcoidosis 1990; 7 (1): 50-7

    PubMed  CAS  Google Scholar 

  11. Rybicki BA, Major M, Popovich Jr J, et al. Racial differences in sarcoidosis incidence: a 5-year study in a health maintenance organization. Am J Epidemiol 1997; 145 (3): 234-41

    Article  PubMed  CAS  Google Scholar 

  12. McNicol MW, Luce PJ. Sarcoidosis in a racially mixed community. J R Coll Physicians Lond 1985; 19 (3): 179-83

    PubMed  CAS  Google Scholar 

  13. Pesut D. The role of central registry in control and research of sarcoidosis in Serbia and Montenegro. Med Pregl 2005; 58: 7-10

    PubMed  Google Scholar 

  14. Gras M, van Kemenade FJ, van Maarsseveen AC, et al. Sarcoidosis: immunopathogenesis and the potential of immunotherapy. Ned Tijdschr Geneeskd 2003; 147 (4): 150-5

    PubMed  CAS  Google Scholar 

  15. Scharkoff T. Apropos of the present level of epidemiologic knowledge on sarcoidosis. Sarcoidosis 1987; 4 (2): 152-4

    PubMed  CAS  Google Scholar 

  16. Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med 1997; 336: 1224-34

    Article  PubMed  CAS  Google Scholar 

  17. Shelly A, Gedalia A. Sarcoidosis [online]. Available from URL: http://www.emedicine.com/ped/topic2043.htm [Accessed 2006 Nov 16]

  18. Mankiewicz E. Die Bedeutung lysogener Mykobakterien fdr die Atiologie der Sarkoidose. Arch Klin Exp Dermatol 1966: 227 (1): 63-77

    PubMed  CAS  Google Scholar 

  19. Gazouli M, Ikonomopoulos J, Trigidou R, et al. Assesment of mycobacterial, propionibacterial and human herpesvirus DNA in tissues of Greek patients with sarcoidosis. J Clin Microbiol 2002; 40: 3060-3

    Article  PubMed  CAS  Google Scholar 

  20. Fite E, Femandez-Figueras MT, Prats R, et al. High prevalence of Mycobacterium tuberculosis DNA in biopsies from sarcoidosis patients from Catalonia, Spain. Respiration 2006; 73 (1): 20-6

    Article  PubMed  CAS  Google Scholar 

  21. di Gennaro G, Ganzonied V, Schioppa O, et al. Discordant HHV8 detection in a young HIV-negative patient with Kaposi’s sarcoma and sarcoidosis. Clin Infect Dis 2001; 32 (7): 1100-2

    Article  PubMed  Google Scholar 

  22. Doyle MK, Berggren R, Magnus JH. Interferon-induced sarcoidosis. J Clin Rheumatol 2006; 12 (5): 241-8

    Article  PubMed  Google Scholar 

  23. Ramos-Casals M, Mana J, Nardi N, et al. Sarcoidosis in patients with chronic hepatitis C virus infection: analysis of 68 cases. Medicine (Baltimore) 2005; 84 (2): 69-80

    Article  CAS  Google Scholar 

  24. Miller-Quernheim J. Immunopathogenesis of sarcoidosis: current practical knowledge. Z Gesammte Inn Med 1990; 19: 573-7

    Google Scholar 

  25. Samtsov AV. Cutaneous sarcoidosis. Int J Dermatol 1992; 31 (6: 385-91

    Google Scholar 

  26. Johns CJ, Michele TM. The clinical management of sarcoidosis: a 50-year experience at the Johns Hopkins Hospital. Medicine (Baltimore) 1999; 78 (2): 65-111

    Article  CAS  Google Scholar 

  27. Katta R. Cutaneous sarcoidosis: a dermatologic masquerader. Am Fam Physician 2002; 65 (8): 1581-4

    PubMed  Google Scholar 

  28. Sharma OP. Sarcoidosis of the skin. In: Freedberg IM, Fitzpatrick TB, editors. Fitzpatrick’s dermatology in general medicine. 5th ed. New York: McGraw-Hill, 1999: 2099-106

    Google Scholar 

  29. Chesnutt AN. Enigmas in sarcoidosis. West J Med 1995; 162: 519-26

    PubMed  CAS  Google Scholar 

  30. Jorizzo JL, Koufman JA, Thompson IN, et al. Sarcoidosis of the upper respiratory tract in patients with nasal rim lesions: a pilot study. J Am Acad Dermatol1990; 22: 439-43

    Article  PubMed  CAS  Google Scholar 

  31. Albertina JG, Tyler W, Miller OF. Ulcerative sarcoidosis: case report and review of the literature. Arch Dermatol 1997; 133: 215-9

    Article  Google Scholar 

  32. Vaskulitis. In: Orfanos CE, Garbe C, editors. Therapie der Hautkrankheiten. 2nd ed. Berlin: Springer, 2001: 487-512

  33. Dal Sacco D, Cozzani E, Parodi A, et al. Scar sarcoidosis after hyalmonic acid injection. Int J Dermatol 2005; 44 (5): 411-2

    Google Scholar 

  34. Jacyk WK. Cutaneous sarcoidosis in black South Africans. Int J Dermatol 1999; 38: 841-5

    Article  PubMed  CAS  Google Scholar 

  35. Katta R, Nelson B, Chen D, et al. Sarcoidosis of the scalp: a case series and review of the literature. J Am Acad Dermatol 2000; 42: 690-2

    PubMed  CAS  Google Scholar 

  36. Cather JC, Cohen PR. Ichthyosiform sarcoidosis. J Am Acad Dermatol 1999; 40 (5 Pt 2): 862-5

    PubMed  CAS  Google Scholar 

  37. Mana J, Marcoval J, Graells J, et al. Cutaneous involvement in sarcoidosis: relationship to systemic disease. Arch Dermatol 1997; 133: 882-8

    Article  PubMed  CAS  Google Scholar 

  38. Aguair M, Felizardo M, Mendez A, et al. Characterization of outpatients with sarcoidosis. Rev Port Pneumol 2005; 11: 30-1

    Google Scholar 

  39. Zic JA, Horowitz DH, Arzubiaga C, et al. Treatment of cutaneous sarcoidosis with chloroquine: review of the literature. Arch Dermatol 1991; 127: 1034-40

    Article  PubMed  CAS  Google Scholar 

  40. Webster GF, Razsi LK, Sanchez M, et al. Weekly low dose methotrexate therapy for cutaneous sarcoidosis. J Am Acad Dermatol 1991; 24: 451-4

    Article  PubMed  CAS  Google Scholar 

  41. Pacheco Y, Marechal C, Marechal Y, et al. Azathioprine treatment of chronic pulmonary sarcoidosis. Sarcoidosis 1985; 2: 107-13

    PubMed  CAS  Google Scholar 

  42. Tuchinda C, Wong HK. Etanercept for chronic progressive cutaneous sarcoidosis. J Drugs Dermatol 2006; 5 (6: 538-40

    Google Scholar 

Download references

Acknowledgments

No sources of funding were used to assist in the preparation of this review. The author has no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Department of Dermatology and Allergy, Skin Cancer Center, Charité-Universitätsmedizin Berlin, Mollwitzstr. 3-5, App 04.05.09, Berlin, 14059, Germany

    Georgi Tchernev

  2. Department of Dermatology and Immunology, Municipal Hospital Dessau, Academic Educational Hospital of the Martin-Luther-University, Halle-Wittenberg, Germany

    Georgi Tchernev

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Correspondence to Georgi Tchernev.

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Tchernev, G. Cutaneous Sarcoidosis: The ‘Great Imitator’. Am J Clin Dermatol 7, 375–382 (2006). https://doi.org/10.2165/00128071-200607060-00006

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