A Case Series of Refractory Cutaneous Sarcoidosis Successfully Treated with Infliximab

Tuchinda, Papapit; Bremmer, Matthew; Gaspari, Anthony A.

doi:10.1007/s13555-012-0011-9

Cited by 15 publications

(9 citation statements)

References 42 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…157,166 TNF inhibitors, specifically adalimumab and infliximab, have shown clearance of chronic, recalcitrant, and severe disease, including lupus pernio, ulcerative sarcoidosis, and lesions not responsive to systemic steroids. [167][168][169][170][171][172][173][174][175][176] Infliximab (dosed at 3-7 mg/kg at 0, 2, and 6 weeks, with maintenance every 4-8 weeks) has been documented to provide rapid control of cutaneous sarcoidosis when systemic steroids were not helpful and for refractory lupus pernio. 171,[173][174][175]177 Similarly, adalimumab (40 mg weekly) has been studied in a prospective, randomized control trial and in case series with documented improvement in refractory skin disease.…”

Section: Differential Diagnosismentioning

confidence: 99%

“…[167][168][169][170][171][172][173][174][175][176] Infliximab (dosed at 3-7 mg/kg at 0, 2, and 6 weeks, with maintenance every 4-8 weeks) has been documented to provide rapid control of cutaneous sarcoidosis when systemic steroids were not helpful and for refractory lupus pernio. 171,[173][174][175]177 Similarly, adalimumab (40 mg weekly) has been studied in a prospective, randomized control trial and in case series with documented improvement in refractory skin disease. [167][168][169][170] Etanercept has not been as well studied, although reports of improvement in skin disease exist.…”

Section: Differential Diagnosismentioning

confidence: 99%

See 1 more Smart Citation

Cutaneous Sarcoidosis

Wanat

Rosenbach

2015

Clinics in Chest Medicine

View full text Add to dashboard Cite

The skin is the second most common organ affected in sarcoidosis, which can affect patients of all ages and races, with African American women having the highest rates of sarcoidosis in the United States. The cutaneous manifestations are protean and can reflect involvement of sarcoidal granulomas within the lesion or represent reactive non-specific inflammation, as seen with erythema nodosum. Systemic work-up is necessary in any patient with cutaneous involvement of sarcoidal granulomas, and treatment depends on other organ involvement and severity of clinical disease. Skin-directed therapies are first line for mild disease, and immunomodulators or immunosuppressants may be necessary.

show abstract

Section: Differential Diagnosismentioning

confidence: 99%

Section: Differential Diagnosismentioning

confidence: 99%

Cutaneous Sarcoidosis

Wanat

Rosenbach

2015

Clinics in Chest Medicine

View full text Add to dashboard Cite

show abstract

“…In the majority of these cases, granulomatous disease was manifested in the skin (18,28,30,33,(55)(56)(57). A beneficial effect of TNF-a inhibition on granulomatous skin disease is also observed in patients suffering from sarcoidosis (92)(93)(94). An illustrative case series by Tuchinda et al, presented three patients that received infliximab for sarcoidosis of the skin showing substantial improvement, of which one showed improvement on infliximab monotherapy.…”

Section: Discussionmentioning

confidence: 99%

What Works When Treating Granulomatous Disease in Genetically Undefined CVID? A Systematic Review

et al. 2020

View full text Add to dashboard Cite

BackgroundGranulomatous disease is reported in at least 8–20% of patients with common variable immunodeficiency (CVID). Granulomatous disease mainly affects the lungs, and is associated with significantly higher morbidity and mortality. In half of patients with granulomatous disease, extrapulmonary manifestations are found, affecting e.g. skin, liver, and lymph nodes. In literature various therapies have been reported, with varying effects on remission of granulomas and related clinical symptoms. However, consensus recommendations for optimal management of extrapulmonary granulomatous disease are lacking.ObjectiveTo present a literature overview of the efficacy of currently described therapies for extrapulmonary granulomatous disease in CVID (CVID+EGD), compared to known treatment regimens for pulmonary granulomatous disease in CVID (CVID+PGD).MethodsThe following databases were searched: Embase, Medline (Ovid), Web-of-Science Core Collection, Cochrane Central, and Google Scholar. Inclusion criteria were 1) CVID patients with granulomatous disease, 2) treatment for granulomatous disease reported, and 3) outcome of treatment reported. Patient characteristics, localization of granuloma, treatment, and association with remission of granulomatous disease were extracted from articles.ResultsWe identified 64 articles presenting 95 CVID patients with granulomatous disease, wherein 117 different treatment courses were described. Steroid monotherapy was most frequently described in CVID+EGD (21 out of 53 treatment courses) and resulted in remission in 85.7% of cases. In CVID+PGD steroid monotherapy was described in 15 out of 64 treatment courses, and was associated with remission in 66.7% of cases. Infliximab was reported in CVID+EGD in six out of 53 treatment courses and was mostly used in granulomatous disease affecting the skin (four out of six cases). All patients (n = 9) treated with anti-TNF-α therapies (infliximab and etanercept) showed remission of extrapulmonary granulomatous disease. Rituximab with or without azathioprine was rarely used for CVID+EGD, but frequently used in CVID+PGD where it was associated with remission of granulomatous disease in 94.4% (17 of 18 treatment courses).ConclusionAlthough the number of CVID+EGD patients was limited, data indicate that steroid monotherapy often results in remission, and that anti-TNF-α treatment is effective for granulomatous disease affecting the skin. Also, rituximab with or without azathioprine was mainly described in CVID+PGD, and only in few cases of CVID+EGD.

show abstract

“…Numerous studies and case series demonstrate efficacy of adalimumab and infliximab in the treatment of severe, ulcerative, or refractory sarcoidosis or for patients with lupus pernio not responsive to other medications. [84][85][86][87][88][89][90] Dosing is 40 mg weekly for adalimumab and 5 mg/kg infliximab at weeks 0, 2, and 6 followed by every other month. Some patients require higher doses of infliximab or a decreased interval to gain control over cutaneous disease.…”

Section: Tnf Inhibitorsmentioning

confidence: 99%

“…Some patients require higher doses of infliximab or a decreased interval to gain control over cutaneous disease. 86,91 Patients who do not respond adequately to one TNF inhibitor can be changed to the other. All patients should be monitored for worsening disease while on TNF therapy, as sarcoid can develop as a response to these medications.…”

Section: Tnf Inhibitorsmentioning

confidence: 99%

Cutaneous Sarcoidosis

Caplan

Rosenbach

Imadojemu

2020

Semin Respir Crit Care Med

View full text Add to dashboard Cite

Sarcoidosis is a chronic, multisystem, inflammatory disorder of unknown etiology that is characterized by noncaseating granulomas that impair normal organ functioning. Sarcoidosis predominantly affects the lungs, but the skin is often cited as the second most frequently involved organ. Cutaneous manifestations of sarcoidosis are highly variable and ongoing research seeks to better understand the relationship between clinical morphology and disease prognosis. Skin findings in patients with sarcoidosis can be “specific,” in which sarcoidal granulomas infiltrate the skin, or they can represent a “nonspecific” reactive inflammatory process, as is seen in calcinosis cutis and erythema nodosum. Cutaneous sarcoidosis can be the initial presenting sign or develop later in the course of the disease. In some patients, the skin will be the most involved and impactful organ system and will drive therapy. In other cases, the skin will be an incidental or minor finding, but may be easily accessible for biopsy to confirm the diagnosis. There are many potential therapies for sarcoidosis, though no one therapy is universally effective.

show abstract

A Case Series of Refractory Cutaneous Sarcoidosis Successfully Treated with Infliximab

Cited by 15 publications

References 42 publications

Cutaneous Sarcoidosis

Cutaneous Sarcoidosis

What Works When Treating Granulomatous Disease in Genetically Undefined CVID? A Systematic Review

Cutaneous Sarcoidosis

Contact Info

Product

Resources

About