Clinicopathologic features, demographics, disease burden, and therapeutics in alopecic sarcoidosis: a case series and systematic review

Abstract

Background: Alopecic sarcoidosis is an uncommon cutaneous manifestation of sarcoidosis. Scarring and nonscarring alopecic sarcoidosis have been reported; however, information on the epidemiology, systemic disease associations, and treatment efficacy is limited.

Objective: To address these gaps, we conducted a retrospective chart review and systematic literature review of alopecic sarcoidosis cases.

Methods: Full-text English publications from PubMed, Scopus, and Google Scholar from inception to August 2023 were analyzed. Treatment evidence quality was assessed using the modified Oxford Centre for Evidence-Based Medicine rating scale. Three patients with biopsy-proven alopecic sarcoidosis were included as a case series, all demonstrating systemic sarcoidosis and 2 requiring multiple therapies. Among 1778 search results, 60 articles representing 77 cases of alopecic and scalp sarcoidosis were included. Patients were categorized into 4 distinct alopecic subgroups. Black patients constituted the majority of all subgroups.

Results: Extracutaneous sarcoidosis burden was high across all alopecic subgroups, with ocular disease appearing overrepresented. Topical and oral corticosteroids were the main treatments. Though scarring alopecia patients had poor outcomes despite receiving immunomodulators/cx, limited data suggest potential efficacy of tumor necrosis factor-alpha inhibitors.

Limitations: This study has a small sample size.

Conclusion: Our findings underscore the importance of evidence-based strategies for improving alopecic sarcoidosis management. Prompt diagnosis and systemic evaluation, especially for scarring alopecia, are essential for timely intervention to optimize patient outcomes.

Keywords: alopecia; cutaneous sarcoidosis; extracutaneous sarcoidosis; nonscarring; sarcoidosis; scarring; skin of color; treatment.

Fig. 1.

Alopecic sarcoidosis. (A) Scarring alopecic, pink, and yellow, scaly patchy on the scalp. (B) Atrophic, pink plaques of scarring alopecia with hyperpigmented borders found to be late-stage scarring alopecic sarcoidosis.

Fig. 2.

Trichoscopy of scalp sarcoid demonstrating yellow globules, telangiectasias, and perifollicular scale. Representative image obtained from an NYU Langone Health patient.

Fig. 3.

Dermal nodular infiltrates of noncaseating granulomas surrounding hair follicle with sparse lymphocytic infiltrate (hematoxylin and eosin). Representative image obtained from the Section of Dermatopathology in NYU Langone Health’s Ronald O. Perelman Department of Dermatology.