Subcutaneous sarcoidosis: A case series of 19 patients

Abstract

Subcutaneous sarcoidosis is a rare variant of this disease, whose relationship with systemic disease is still controversial. Our objective was to describe the clinical characteristics of a series of patients with subcutaneous sarcoidosis and to investigate the relationship between these skin lesions and the disease's activity, severity, and prognosis. Nineteen patients with biopsy-confirmed subcutaneous sarcoidosis between 2009 and 2019 were selected. Mean age at diagnosis was 53 years. Lung involvement was detected in 10 patients (52.6%), mainly in stages I and II. Only two patients (10.5%) had additional systemic signs and five patients (26%) suffered from other autoimmune diseases simultaneously. Six patients (31.6%) had elevated angiotensin-converting enzyme levels (mean level 174.5 U/L). Eight patients (42%) received treatment, mainly systemic corticosteroids, and all patients except for one had a favorable clinical outcome. Subcutaneous sarcoidosis is frequently associated with a mild form of systemic disease, and the prognosis seems favorable regardless of treatment. Sarcoid nodules could be an early finding of systemic disease, allowing for less invasive procedures for histological confirmation.

Keywords: Darier-Roussy's sarcoid; disease severity; sarcoidosis; skin; subcutaneous nodules.

Figure 1

Histopathologic figures of cutaneous sarcoidosis. (a) Multiple non-caseating granulomas were found infiltrating the dermis and subcutis (black arrows) (H&E, x40). (b) Granulomas were composed of epithelioid macrophages (yellow arrow), multinucleated giant cells (green arrow) and a small number of lymphocytes (thin black arrow) (H&E, x200)

Figure 2

Multiple subcutaneous nodules on the extensor aspect of the right forearm of patient 5. Lesions were painless and had a firm consistency