Histologic findings. Skin biopsy demonstrating noncaseating granulomas provides definitive evidence of skin involvement. Typical sarcoid lesions are characterized by circumscribed granulomas of epithelioid cells with little or no necrosis. (The term “naked” granuloma refers to the absence, or small number, of surrounding lymphocytes.)
Other granulomatous diseases, such as berylliosis and tuberculosis, must be excluded since they often present the same way as scar sarcoidosis.7
Steroids control symptoms, slow disease progression
Topical, intralesional, and systemic corticosteroids are used to treat scar sarcoidosis, as are systemic medications such as chloroquine10 and allopurinol.11 Corticosteroids (local and systemic) are effective in controlling all sarcoid symptoms; they also slow disease progression.1
For localized skin involvement, intralesional corticosteroids are typically more effective than topical steroids. Systemic corticosteroids are reserved for widespread, progressive lesions or those that impair function.1,12,13 A starting dose of 1 mg/kg of prednisone is appropriate.
In general, the prognosis of cutaneous sarcoidosis is good.2 The course is variable, ranging from self-limited acute episodes to a chronic debilitating disease that may result in death.2 Spontaneous remissions occur in nearly two thirds of patients, but 10% to 30% have a more chronic or progressive course.1,2,13
Our patient responds to treatment
Our patient declined intralesional corticosteroid injections, so we started her on potent topical corticosteroid tapes (Cordran). She had significant improvement 6 weeks later.
Correspondence
Amor Khachemoune, MD, CWS, 450 Clarkson Avenue Box 46, Brooklyn, NY 11203; amorkh@pol.net