The skin in sarcoidosis
About one-third of patients with systemic sarcoidosis have skin lesions; it is also possible to have cutaneous sarcoidosis without systemic abnormalities. The most important skin changes are as follows.
1 Erythema nodosum (see Fig. 8.10). This occurs in theearly stages of sarcoidosis, especially in young women.
2 Scar sarcoidosis. Granulomatous lesions arisingin longstanding scars should raise suspicions of sarcoidosis.
3 Lupus pernio. Dusky infiltrated plaques appearon the nose and fingers, often in association with sarcoidosis of the upper respiratory tract.
4 Papular, nodular and plaque forms(Fig. 19.6).These brownish-red, violaceous, or hypopigmented papules and plaques are indolent although often symptom-free. Sometimes they are annular. They vary in number, size and distribution. Intralesional and topical corticosteroids are sometimes helpful and hydroxychloroquine has been used successfully. Chronic lesions respond poorly to any line of treatment short of systemic steroids, which are usually best avoided if involvement is confined to the skin.