Split‐Thickness Skin Grafting in Extensive Ulcerative Sarcoidosis

Abstract

A 64-year-old white male had extensive ulcerative cutaneous sarcoidosis of the lower extremities. After stabilization with methotrexate and prednisone therapy, the ulcers were debrided and covered with split-thickness skin grafts. An 80% graft acceptance was maintained 2 months later. Successful grafting of ulcerative sarcoidosis has not been reported previously.

Clinicopathologic features of ulcerative‐atrophic sarcoidosis

“…Various surgical approaches have also been attempted with little success. Split‐thickness skin grafting failed in one case 12 and, in another that had initially been successful, additional ulceration eventually developed 21 . Methotrexate has been effective in some cases, 22 although in others its use has been limited by liver toxicity 4 …”

Multisystemic Sarcoidosis Presenting as Pretibial Leg Ulcers

“…Our patient developed secondary cutaneous signs, that is, pretibial ulcers. Leg ulcers are a rare cutaneous manifestation of sarcoidosis and can be either due to secondary ulceration of specific cutaneous infiltrates with sarcoid granulomas, 5-12 granulomatous vasculitis, 13 or are nonspecific (Table 1). The largest series has been published by Albertini et al, 4 with a review of 29 cases presenting with leg ulcers, all with proven sarcoid granulomas.…”

Ulcerative Sarcoidosis

“…In 6 patients pain was noted as a prominent feature.13,17,28"31 Ulcers tended to heal with scar¬ ring.13,2632 The time from ulcération to diagnosis by bi¬ opsy was less than 1 year in 25 of 32 patients. In 7 of 32 patients, the cause of the ulcérations was not recog¬ nized as sarcoidosis for more than 3 years.14, 16,18,20,26,33 No increased mortality rate was observed for those patients with a delayed diagnosis, and they responded similarly to treatment.…”