Skin sarcoidosis diagnosis

In the United States, chronic skin sarcoidosis is more common in African Americans than Caucasians. In ACCESS, where patients were evaluated within six months of diagnosis, 19.7 % (64/325) of African Americans had specific (granulomatous) sarcoidosis skin lesions compared to 13.0% (51/393) of Caucasians (chi-square = 5.5, p < 0.05) (25). 

The diagnosis of specific sarcoidosis skin lesions usually requires a confirmatory biopsy. On occasion, a clinical diagnosis of skin sarcoidosis may be made if the lesions are typical (e.g., lupus pernio or lesions present on scar tissue). Sarcoidosis is not the only cause of granulomatous inflammation of the skin, and other potential causes must be carefully excluded. Usually the diagnosis of skin sarcoidosis is not secure without evidence of extracutaneous granulomatous disease. 

The diagnosis of skin sarcoidosis tends to be made rapidly relative to other organ involvement with sarcoidosis because the skin lesions are evident and can be easily biopsied. In a cohort of ACCESS patients, the patients with skin sarcoidosis were diagnosed significantly faster than those with pulmonary sarcoidosis (30). Patents with nonspecific skin lesions such as erythema nodosum do not demonstrate granulomatous inflammation on biopsy. Therefore, skin biopsies should be avoided in these patients as the procedure has no value in their diagnosis. 

Data from ACCESS suggest that granulomatous skin involvement develops more commonly than other new organ involvement within the first two years of the diagnosis of sarcoidosis [13/215 (6%)] (30). Although not subjected to statistical analysis, these ACCESS data suggested that new onset skin involvement was more common in African Americans than Caucasians [10/93 (10.7%) versus 3/117 (2.6%)]. 

Skin/respiratory - sarcoidosis A female patient with multiple sclerosis developed sarcoidosis 3 years after continuous therapy with IFNp. The patient presented witir low-grade fevers, dyspnoea on exertion, diffuse arthralgias and rash. Noncaseating granulomas and endobronchial biopsies of pulmonary lymph nodes contributed to the diagnosis of sarcoidosis. Withdrawal of IFNp combined with a course of corticosteroids and antirheumatic drug therapy led to resolution of the condition [60 ]. 

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