Ulcerative Sarcoidosis Successfully Treated with Apligraf

Abstract

The case of a 73-year-old female patient is reported with a 25-year-long history of widespread cutaneous sarcoidosis without any known extracutaneous manifestations. The skin manifestations started with erythematous and plaque-like lesions that had ulcerated on the legs for the last half-year. A relevant venous insufficiency or other etiology of the ulcers could not be found. Histology from lesions of the trunk and from the surroundings of the ulcers revealed the typical noncaseating granulomas. A systemic involvement could not be observed; leukopenia and a slightly elevated angiotensin-converting enzyme level in the serum were found. Topical steroids did not prove successful on the ulcers. Apligraf, a bilayered skin equivalent, was transplanted twice on the ulcers leading to complete closure within 3 months. A therapy with systemic steroids could thus be avoided.

Sarcoidosis: A comprehensive review and update for the dermatologist

“…The ulcers usually do not heal without topical or systemic immunosuppressive or immunomodulatory therapy, although one case responded to a living bilayered skin graft. 65 In a retrospective study of 147 cases of cutaneous sarcoidosis, seven cases (5%) had ulcerative sarcoidosis, suggesting that it is more common than the literature suggests, at least in Japanese and African American patients. 66,67 The suggestion that this type of sarcoidosis is increasing may be related to a greater number of biopsy specimens of nonhealing ulcers in specialized wound care centers.…”

The role of fibroblasts in tissue engineering and regeneration

“…Although this is only one case report of the use of Apligraf ® for pyoderma gangrenosum, the advantage of using a readily available skin substitute in this particular instance is that it avoids the necessity of harvesting autologous skin for expansion and the subsequent possibility of inducing a pathergic response 53 . Other dermatological conditions in which Apligraf ® has been applied and led to successful wound healing include hydroxyurea‐induced leg ulcers, bullous morphoea ulcers and ulcerative sarcoidosis 54–56 …”

“…53 Other dermatological conditions in which Apligraf Ò has been applied and led to successful wound healing include hydroxyurea-induced leg ulcers, bullous morphoea ulcers and ulcerative sarcoidosis. [54][55][56] Cosmetic and reconstructive surgery Tissue-engineered skin substitutes have also been used for the treatment of wounds following cancer excision. They have the advantage of promoting normal tissue repair without the need to induce donor-site defects as well as allowing monitoring for local tumour recurrence.…”

Skin substitutes in dermatology

“…[30] Other researchers have used melanocyte cultures with satisfactory results. [31,32] Other skin disorders Skin substitutes have also been applied successfully in healing of wounds in cases of epidermolysis bullosa, [33] aplasia cutis, [34] harlequin ichthyosis, [35] ulcerative sarcoidosis, [36] necrobiosis lipoidica, [37] and bullous morphea. [38] B.…”