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Abstract Sarcoidosis is a multisystem granulomatous disorder of uncertain aetiology, manifesting with cutaneous features in one-third of affected individuals. We retrospectively reviewed medical records of patients with a clinical diagnosis of cutaneous sarcoidosis in dermatology departments within our region. Sixty-five patients were identified. The mean age at presentation was 49 years (range 28–75), with increased prevalence in women (44, 68%). Twenty-six patients (40%) had localized disease affecting a single anatomical location, three of which were within tattoos. Thirty-nine (60%) had involvement of at least two anatomical locations. Limbs were the most frequently affected site (41). Other affected areas were the face (32), torso (25), scalp (9) and neck (5). Plaques were the most common morphology, seen in 26 cases, followed by papules (23), nodules (23), patches (6), erythema nodosum (4), annular (3), ulceration (3) and subcutaneous nodules (3). The colours of lesions were erythematous (37), yellow–orange–brown (22), violaceous (9) and skin coloured (5). All patients had biopsy-proven noncaseating granulomas; 60 patients had this confirmed on skin biopsy and five patients from other organs. In total, 41 patients (63%) had systemic sarcoidosis. Twenty-four of those with systemic sarcoid osis (59%) had cutaneous signs as their first presentation of sarcoid osis. Pulmonary sarcoidosis was diagnosed in 36 (55%), with relevant findings on chest X-ray, computed tomography of the thorax and/or pulmonary function tests. Of these, 22 patients did not report respiratory symptoms. Other organs involved were eye (6), joint (6), extrapulmonary lymph nodes (5), liver (4), cardiac (3), central nervous system (2) and renal (2). Lymphopenia was detected in 14 (22%) and anaemia in six (9%) patients. Twenty-three (35%) had elevated serum angiotensin-converting enzyme (ACE) levels. Four patients with elevated serum ACE levels did not have systemic sarcoidosis. Twenty-two of 41 patients with systemic sarcoidosis did not have elevated serum ACE levels. Complete resolution of skin lesions was observed in 32 patients. Management included watchful monitoring (8), potent or superpotent topical steroids (11), short courses of prednisolone (3), antimalarials (3), intralesional steroids (2), methotrexate (1), tofacitinib (1), and treatments initiated for systemic sarcoidosis including long-term prednisolone (3) and adalimumab (1). Our study highlights a lack of correlation between clinical features of cutaneous disease and systemic involvement. We found no association between biochemical profile and severity of sarcoidosis, or disease progression. It underscores the importance of maintaining a high index of suspicion and conducting thorough investigations for early detection of extracutaneous disease, as patients with extensive systemic sarcoidosis may be asymptomatic.
Hiranput et al. (Fri,) studied this question.