Sarcoidosis (cutaneous manifestations)

The cutaneous manifestations of sarcoidosis occur in ~30% (range 9-37%) of patients with sarcoidosis. A skin lesion may be the initial presentation of sarcoidosis and the majority of patients with cutaneous manifestations will have pulmonary disease.

Pathology

Common lesions

• maculopapular lesion
  • most common lesion seen in sarcoidosis
  • usually on the face and neck
  • often tansient
• erythema nodusum
  • painful red nodular rash
  • not specific for sarcoidosis
  • more common in women then men and in northern Europeans
  • associated with a more favorable prognosis
• granulomata
  • non-caseating subcutaneous granulomata
  • common on the forearms
• plaques
• lupus pernio
  • most characteristic skin lesion of sarcoidosis
  • red or violaceous indurated skin lesion usually on the face
  • more common in women then men and individuals with black skin
  • invades deeper soft tissues including underlying bone
  • associated with:
    • more aggressive disease course
    • bone cysts
    • sarcoidosis of the upper respiratory tract (SURT)
    • uveitis
• scar sarcoidosis
  • granulomatous infiltration into scars
  • common in the knee

Less common lesions

• ulcerative lesions
• psoriform plaques
• hypopigmentation
• alopecia
• papillomatous lesions
• lichenoid lesions
• pustular folliculitis