Cutaneous sarcoidosis
Overview
- Epidemiology: F: M ≈ 2: 1, more common in Africans (in DE also German / Scandinavian population). First manifestation 20–40 years.
- Pathogenesis Hypothesis: Misdirection by Antigen presentation of infectious triggers with CD4 T-cells + IL-2 + ACE.
- Clinical Features: Multiorgan involvement possible — Skin + lungs + eyes + kidneys (lungs > 90% bilateral hilar).
- Skin findings: lupoid plaques (“Lupus pernio”), macules, annular / psoriasiform / ichthyosiform variants, scar sarcoidosis in tattoos / scars.
- Lupus pernio: livid-red to bluish-violet, doughy infiltrated plaques on the nose, cheeks, earlobes and fingers — the hallmark of chronic persistent sarcoidosis, frequently associated with involvement of the nasal mucosa and upper airways and with fibrosing pulmonary disease; prognostically unfavourable and often refractory (MTX, hydroxychloroquine, anti-TNF in reserve — exclude TB beforehand). Despite the name it has no relationship to the chilblain lupus of lupus erythematosus.
| Feature | Lupus pernio | Rosacea |
|---|---|---|
| Colour | livid-bluish, "chilblain-like" | bright red to coppery red |
| Telangiectasias | absent | characteristically present |
| Papulopustules | none | typical |
| Surface | doughy infiltrated, smooth plaque | papules/pustules, bulbous in the phyma stage |
| Diascopy (glass spatula) | apple-jelly colour of the granuloma | erythema blanches |
| Histology | non-caseating epithelioid granulomas | perifollicular inflammation; granulomas only in granulomatous rosacea |
| Systemic signs | lungs, eyes, raised sIL-2R and ACE | none |
| Flush/triggers | none | heat, alcohol, spicy food |
- Special Forms:
- Löfgren's Syndrome: Triad is EN + ankle arthritis + bilateral hilar LAP — good prognosis.
- Heerfordt's Syndrome (Uveoparotid fever): Uveitis + parotitis + facial nerve palsy ± fever — cranial nerve involvement typical.
- Diagnostics: Chest X-ray + sIL-2R + ACE with non-caseating granulomas.
Differential diagnoses
- Lupus erythematosus gesicht
- Rosacea
- Granuloma annulare
- Lepromatous leprosy
- Mycosis fungoides
- Lupus Pernio (Sarcoidosis)
- Granuloma faciale
- Secondary syphilis (lues II)
Practise Cutaneous sarcoidosis in the app
Flashcards with spaced repetition, exam questions and spot-the-diagnosis on this topic – in DermaFuchs, free of charge.
In the DermaFuchs app: 10 flashcards · 4 clinical images
Open in browser Download on the App StoreSources (selection)
More inflammatory skin diseases
- Cheilitis granulomatosa (Miescher)
- Erythema annulare centrifugum (EAC)
- Erythema nodosum
- Graft-versus-host disease (GvHD)
- Granuloma annulare
- Lichen planus
- Lichen sclerosus
- Lichenoid drug eruption
Note: This page is intended for medical education and does not replace diagnosis or treatment decisions in individual cases. Treatment and follow-up content is available in the app.