Diagnosis of cutaneous sarcoidosis; clinical and the prognostic significance of skin lesions

Abstract

BackgroundSarcoidosis is a systemic disease characterized by the formation of noncaseating granulomas in various tissues. Cutaneous involvement occurs in 20 to 35 percent of the patients and may be the initial manifestation of the disease. Our study was performed to discriminate the clinical, laboratory, and prognostic differences between patients with specific and nonspecific cutaneous involvement. The second aim was to asses the diagnostic usefulness of punch biopsy in sarcoidosis.MethodsThe clinical, laboratory, pathological features, and skin biopsy results of 120 patients with cutaneous sarcoidosis were evaluated. The patients fulfilled clinical, radiologic or both features of sarcoidosis supported by the histopathologic evidence of noncaseating granulomas.Skin involvement was the initial finding in 30% of the patients. Erythema nodosum and lupus pernio were the most common skin lesions. Almost all of the patients with LP were either stage 0 or 1. Respiratory symptoms occurred in 72.2% of the patients with specific skin involvement. BronchoalveolarLavage (BAL) lymphocytosis, high ratio of CD4/CD8 and elevated serum Angiotensin Converting Enzyme (ACE) were more frequent in patients with specific cutaneous lesions. The frequency of progressive disease was significantly higher in this group. Punch skin biopsy was diagnostic in 81.6% of the patients with a complication rate of 4%.ConclusionsSpecific cutaneous lesions along with BAL lymphocytosis, high CD4/CD8 ratio and elevated serum ACE levels may be predictors of progressive disease in sarcoidosis. Punch biopsy is a simple technique with a high diagnostic yield and a low complication rate for cutaneous sarcoidosis.

Sarcoidosis

“…5 Clinical manifestations of systemic sarcoidosis are diverse (see Table 3) Approximately one-third of patients present with vague constitutional symptoms such as fatigue, fever, nights sweats, and weight loss. 102 Pulmonary sarcoidosis is clinically and pathologically the most common manifestation of the disease.…”

“…4 Cutaneous sarcoidosis is the initial manifestation of the disease in nearly one-third of patients. 5 The skin (as well as the liver, spleen, and lymph nodes) is most often involved in African Americans. …”

Plantar subcutaneous sarcoidosis – a rare form of skin sarcoidosis: unusual plantar aponeurosis location of sarcoidosis as primary manifestation of asymptomatic systemic disease

“…Maña et al 5 identified the absence of erythema nodosum as a variable independently influencing activity persistence in sarcoidosis. Yanardag et al 6 found that the frequency of progressive disease was more significant in patients with specific cutaneous lesions. However, the prognostic significance of subcutaneous sarcoidosis because of the limited sample size in the studies has not been clearly established.…”

INTERACTIVE CASE REPORT: A Case of Sarcoidosis with Psoriasis like Skin Involvement

“…Ayrıca bu hastaları çoğunlukla ilk olarak değerlen-diren hekimler olan dermatologların, hastayı sistemik tutulum açısından değerlendirmesi önem arz etmektedir. Tanıda punch biyopsi oldukça kolay ve güvenilir bir yön-temdir (11). Ancak granülomatöz iltihap yapan diğer hastalıklar tüberküloz, atipik mikobakteri enfeksiyonları, fungal enfeksiyonlar, yabancı cisim reaksiyonları ve romatoid nodüller histopatolojik ayırıcı tanıda göz önünde bulundurulmalıdır (3,12).…”

“…Bu kapsamda muhtemel enfeksiyöz nedenleri dışlamak için alınan örneklerin spesifik ve nonspesifik kültürü, serolojik değerlendirme, tüberkülin testi, serum ACE düzeyi yardımcı olabilir. Özellikle spesifik deri tutulumu olan hastalarda ACE düzeyi belirgin olarak yüksek bulunmuştur (11). Bir çalışmada sarkoidoz deri tutulumu olan hastalar ile psöriyazis olguları karşılaş-tırılmış ve sarkoidozda ACE düzeyleri daha yüksek bulunmuştur (13).…”