Successful Treatment of Cutaneous Sarcoidosis Using Topical Photodynamic Therapy

A 67-year-old woman had a 17-year history of increasing numbers of asymptomatic but disfiguring red-brown, flat papules on the extremities. She was otherwise well and had no pulmonary or systemic symptoms. Seven years ago, the patient was referred to our department, and the diagnosis of cutaneous sarcoidosis (small nodular type) was repeatedly confirmed by skin biopsy results. The physical examination revealed numerous painless, red-brown, slightly elevated papules and plaques up to 1 cm in diameter, disseminated and partially confluent at the extensor aspects of the legs and to a lesser extent on the upper arms (Figure 1). On results of diascopy, the lesions appeared gray yellowish. Other body areas were not affected. Results of the histological evaluation of formalinfixed, paraffin-embedded biopsy specimens repeatedly obtained from the lesional skin revealed noncaseous epithelioid-cell granulomas with several multinucleated foreign body giant cells and a sparse perifocal lymphohistiocytic infiltrate in the dermis. Results of examination of sections stained with periodic acid–Schiff and Ziehl-Neelsen failed to detect fungi or acid-fast bacilli, respectively. Special cultures repeatedly yielded negative findings for mycobacteria. Results of internal examinations showed no lung involvement, and pulmonary function test findings were normal. Findings on chest x-ray examination, electrocardiography, abdominal ultrasonography, and neurologic and ophthalmologic examinations revealed no abnormalities. No enlarged peripheral lymph nodes or parotid glands were seen. Laboratory investigations, including complete blood cell count, liver and renal function tests, serum electrophoresis, and measurement of electrolyte (including calcium), angiotensin-converting enzyme, 2-microglobulin, and -globulin concentrations, were within reference limits. The erythrocyte sedimentation rate and antinuclear antibody concentration were slightly raised. Results of the tine tuberculin reaction test were positive ( 3), whereas acute tuberculosis and former bacille Calmette-Guerin vaccination were excluded.