Nodules on nose and tattoos

For most cutaneous lesions, intralesional corticosteroids and/or hydroxychloroquine followed by methotrexate can be effective.

Antimalarials such as hydroxychloroquine (200 mg twice a day for at least 6 months) or methotrexate (10-15 mg/week taken at once orally or as a subcutaneous or intramuscular injection) can also be helpful. Treatment with a midpotency topical corticosteroid such as triamcinolone 0.1% cream twice a day and doxycycline hyclate (100 mg twice a day for 4 months) has been reported to clear cutaneous lesions in tattoos.³

Oral corticosteroids are the gold standard for severe cutaneous sarcoidosis, but their multiple adverse effects, such as diabetes and adrenal suppression, may prevent prolonged use.⁸ For most cutaneous lesions, intralesional corticosteroids and/or hydroxychloroquine followed by methotrexate can be effective.⁸

The nodules on our patient’s nose were successfully treated with intralesional triamcinolone 5 mg/mL. No treatment was initiated for the tattoo nodules because they were asymptomatic and the patient was not concerned about their appearance. He continues to get new tattoos, but is minimizing the use of red ink.

The patient was also started on prednisone 10 mg/d, which improved his hand swelling. Rheumatologists were considering a steroidsparing immunosuppressive agent such as methotrexate; however, the patient was lost to follow-up.

CORRESPONDENCE
Jinmeng Zhang, MD, Division of Dermatology, Washington University School of Medicine, St. Louis, MO 63110; jinmeng.zhang1@gmail.com