Generalized ulcerative sarcoidosis

Abstract

Cutaneous involvement is present in approximately 25% of patients with sarcoidosis. A large variety of morphologic patterns has been well described; ulcerative lesions are rare. A 30-year-old black man had generalized cutaneous granulomas, many of which demonstrated superficial ulceration. The exudative quality of these lesions was probably secondary to recurrent bacterial infection. Use of oral antibiotics, prednisone, and hydroxychloroquine sulfate controlled his disease activity.

Mutilating Facial Sarcoidosis

“…Therapy of mutilating cutaneous sarcoidosis is not easy [3, 4, 19, 20]. In our patient, 7 months of therapy with hydroxychloroquine sulfate did not produce any reduction in the size of the nodules.…”

“…Lupus pernio describes a form of sarcoidosis with violaceous plaques on the central face [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11]. It was first described by Ernest Besnier in 1889 [12].…”

“…It is a violaceous, indurated plaque that is characteristically located on the nose, ears, lips and other areas of the face. Typically seen in women, lupus pernio is associated with chronic, persistent sarcoidosis that has a predilection for upper respiratory involvement [1, 2, 3, 4, 5, 6, 7, 8, 9, 10]. However, frank cutaneous tumors are rarely seen in lupus pernio.…”

Sarcoidosis with Extensive Cutaneous Ulceration

“…The ulcer ation may result from marked epithelioid cell proliferation in the dermis producing necrosis of the overlying epidermis [6]. Deposition of circulating immune com plexes within endothelial cell gaps produc ing cutaneous injury with ulceration and granulomatous formation has been suggest ed [4]. Hyaline degeneration and infiltration of the blood vessels in the deep dermis have been implicated [7], In our patient the com plement levels were normal and no hyaline degeneration was present.…”

“…However, cutane ous ulcerative sarcoidosis has since been reported [4][5][6][7], The ulcerations occur most frequently on the legs, other areas being less commonly affected [4,5]. The lesions may simply be tender ulcers approximately 1-2 cm in size, or appear as ulcerations in plaques or nodules.…”