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Management of cutaneous sarcoidosis

Authors
Steven Prystowsky, MD
Miguel Sanchez, MD
Section Editor
Jeffrey Callen, MD, FACP, FAAD
Deputy Editor
Abena O Ofori, MD

INTRODUCTION

Sarcoidosis is a multisystem granulomatous disease characterized by the presence of noncaseating granulomas in organ tissue. Skin involvement is common, and a variety of therapeutic interventions have been utilized for the treatment of cutaneous disease. However, scientific support for most treatments for cutaneous sarcoidosis is limited to observational studies, uncontrolled prospective studies, small case series, individual case reports, and opinions of respected authorities. When managing patients with cutaneous sarcoidosis, clinicians must first consider whether treatment is indicated. The options available for the treatment of skin lesions include both local and systemic therapies.

The treatment of the cutaneous manifestations of sarcoidosis will be reviewed here. The clinical manifestations of cutaneous sarcoidosis and the management of other forms of sarcoidosis are discussed separately. (See "Cutaneous manifestations of sarcoidosis" and "Treatment of pulmonary sarcoidosis with glucocorticoids" and "Treatment of pulmonary sarcoidosis with alternatives to glucocorticoids" and "Cardiac sarcoidosis" and "Neurologic sarcoidosis" and "Renal disease in sarcoidosis" and "Gastrointestinal and hepatic sarcoidosis" and "Sarcoid arthropathy".)

APPROACH TO THERAPY

Although cutaneous sarcoidosis is not life-threatening and leads to physical impairment in only a minority of patients, the psychological and social impact of the disease can be devastating, supporting the need for treatment. In general, treatment is indicated in patients with cosmetically disfiguring, symptomatic, ulcerating, or progressively worsening skin disease.

However, the decision to treat is complicated by the unpredictable course of the disease (which includes the possibility for spontaneous remission in up to two-thirds of patients [1,2]), variability in the response to treatment, and the severe adverse effects associated with some therapies. In patients with stable, asymptomatic disease that is not associated with cosmetic disfigurement, forgoing treatment is reasonable.

Choice of therapy — When cutaneous lesions are the only indication for treatment of sarcoidosis, the risks and benefits of treatment must be considered carefully. Few randomized trials have evaluated the efficacy of therapies for cutaneous sarcoidosis, and data on the various treatment options are primarily limited to the results of small uncontrolled prospective studies, retrospective analyses, and case reports [3,4].

                            

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