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Clinical
spectrum and histological analysis of 32 cases of specific cutaneous
sarcoidosis.J
Cutan Pathol. 2006 Dec;33(12):772-7.
BACKGROUND:
Sarcoidosis is a multisystem granulomatous disorder of unknown
aetiology in which skin involvement is frequent. OBJECTIVE: To
review histological characteristics of biopsies of specific
cutaneous lesions of sarcoidosis and their relationship with
clinical course. PATIENTS AND METHODS: Biopsies from 32 patients
with specific cutaneous sarcoidosis were reviewed. Histological
findings and clinical characteristics of these patients were
analysed. RESULTS: The initial clinical lesions of the patients were
ten infiltrated nodule-plaques, eight papules, four maculopapular
eruptions, five scar sarcoidosis, four subcutaneous nodules and one
lupus pernio. Sarcoidal granulomas were located at dermis in 31
cases (74%) and at subcutaneous fat in 12 (28%) but only four were
subcutaneous exclusively. Perivascular or periannexial distribution
of granulomas was observed in eight cases (19%) and they had
coalescence in 29 samples. The presence of foreign material was
demonstrated in 11 cases (26%). CONCLUSIONS: Clinical spectrum of
specific lesions of cutaneous sarcoidosis showed a good correlation
with granulomas localization in the biopsies. However, traditional
classification of specific cutaneous sarcoidosis is often
overlapping. On the other hand, foreign bodies and other atypical
histological findings were more common than initially expected.
Subcutaneous sarcoidosis: is it a specific subset of cutaneous
sarcoidosis frequently associated with systemic disease?J
Am Acad Dermatol.2006 Jan;54(1):55-60. Epub 2005 Dec 2.
BACKGROUND:
Skin is involved in 25% of cases of sarcoidosis. The lesions are
specific and nonspecific depending on the presence or absence of
granulomas, respectively. Specific lesions are not thought to have
prognostic significance and are not associated with systemic
disease. OBJECTIVE: We sought to evaluate for the presence or
absence of systemic disease in patients with subcutaneous
sarcoidosis. METHODS: With diagnostic criteria of subcutaneous
sarcoidosis, 33 cases were identified in the literature and 21 cases
in our institutional database. A retrospective clinical and
pathologic review of these cases was conducted. RESULTS:
Subcutaneous sarcoidosis is characterized by a peak incidence during
the fourth decade; female predisposition; asymptomatic to slightly
tender lesions typically involving the upper extremities; cutaneous
lesional clustering and multiplicity; autoimmune disease
associations at time of diagnosis in a subset of cases; systemic
disease associations at diagnosis in most patients, typically
consisting of bilateral hilar adenopathy; and a favorable response
to oral corticosteroid therapy. LIMITATIONS: Retrospective analysis
with inadequate documentation of therapeutic regimens and their
responses in some cases is a limitation of this study. CONCLUSIONS:
The confirmatory diagnosis of subcutaneous sarcoidosis depends on
identifying pannicular noninfectious sarcoidal or epithelioid
granulomas with minimal lymphocytic inflammation. Subcutaneous
sarcoidosis is the only specific subset of cutaneous sarcoidosis
frequently associated with systemic disease.
The histologic spectrum of cutaneous sarcoidosis: a study of
twenty-eight cases. J Cutan Pathol.2004
Feb;31(2):160-8
BACKGROUND:
Naked sarcoidal granulomas (NSGs) are the characteristic histologic
finding in sarcoidosis. This descriptive study was designed to
identify the frequency of other histologic changes in cutaneous
sarcoidosis. METHODS: The slides from 28 sequential biopsies
previously diagnosed as sarcoidosis in patients with known systemic
sarcoidosis were reviewed. RESULTS: Classic NSGs were identified in
25 biopsies (89%). Four biopsies contained tuberculoid granulomas,
two with neutrophils suggesting infection (cultures negative). Five
biopsies contained interstitial granulomas that resembled granuloma
annulare and necrobiosis lipoidica in one case each. Additional
histologic findings included birefringent foreign material in 14
biopsies (50%), focal necrosis (43%), elastophagocytosis (39%),
linear peri-neural granulomas resembling leprosy (25%), increased
dermal mucin (18%) and lichenoid inflammation (14%) [two with plasma
cells resembling syphilis (7%)]. In all but three cases, the
clinical morphology of the lesions suggested sarcoidosis. Special
stains for mycobacteria and fungi were negative. CONCLUSIONS: The
histologic changes in cutaneous sarcoidosis are more diverse than
previously recognized. In sarcoidosis, foreign material may be a
frequent nidus for cutaneous granuloma formation. Histologic
examination without the clinical history could lead to a
misdiagnosis of leprosy, syphilis, other infectious granulomas,
rosacea, granuloma annulare, necrobiosis lipoidica, and foreign body
reaction in selected cases from this series.
Cutaneous involvement in sarcoidosis. Relationship to systemic
disease.
Arch Dermatol.1997
Jul;133(7):882-8
Sarcoidosis is
an antigen-mediated disease defined by granuloma formation in
different organs. It involves mainly the mediastinal and peripheral
lymph nodes, lungs, eyes, skin, liver, and spleen. Cutaneous lesions
of sarcoidosis may be specific, showing histologically noncaseating
granulomas, or nonspecific, most typically erythema nodosum.
Frequently, both types of skin lesions are the means of presentation
of the disease and may contribute to the diagnosis. A workup for
systemic sarcoidosis should be undertaken in every patient with
sarcoid cutaneous granulomas. Some types of cutaneous lesions have
prognostic significance. Lupus pernio and plaques are associated
with more severe systemic involvement and more chronic course, while
erythema nodosum is the hallmark of acute and benign disease.
Sarcoidosis of the skin. Nippon Rinsho.1994
Jun;52(6):1603-7
Sarcoidosis
is characterized by formation of epithelioid-cell tubercules,
without caseation, of the affected organ systems. The mediastinum,
peripheral lymph nodes and eyes, in addition to the skin, are most
frequently affected. Between 10% and 30% of patients with systemic
sarcoidosis in Japan have skin lesions. Skin sarcoidosis is
morphologically classified into three basic groups, erythema nodosum,
scar sarcoidosis and skin sarcoid. Skin sarcoid is characterized by
specific cutaneous lesions of sarcoidosis, and may take nodular,
plaque, angiolupoid, subcutaneous and some other forms. Clinical
manifestations of the cutaneous lesions are usually asymptomatic and
polymorphous. Skin biopsy is, however, often highly useful for
confirming a diagnosis of sarcoidosis. |
