A 14‐year‐old girl with lichenoid sarcoidosis successfully treated with tacrolimus

Abstract

We report a case of lichenoid sarcoidosis in a young girl treated by oral tacrolimus and methylprednisolone. The patient had had a skin eruption from 1 year of age and had developed uveitis at 2 years of age. Her sight had become affected by the uveitis at 8 years of age. When she was 14, she was admitted to the ophthalmology department of our hospital to start treatment with tacrolimus (FK506). She was referred to the department of dermatology for her skin lesions, which were flat, pinkish or normal skin-colored papules scattered on her extremities and the backs of her hands. Upon histology, epithelioid granulomas were seen in the upper dermis and around the erector pili muscles. She received tacrolimus (FK506) 6 mg/day for 3 months for her uveitis. The eye lesions subsided somewhat, and the skin lesions were almost healed after the 3-month course of tacrolimus. However, 4 months after stopping the tacrolimus, her skin and eye lesions relapsed. At that point, she was started on methylprednisolone 16 mg/day for her uveitis. With the methylprednisolone treatment, the inflammation of the eye lesion immediately healed, as did the skin lesions.

Lichenoid Sarcoidosis: A Case With Clinical and Histopathological Lichenoid Features

“…18 Lichenoid lesions have been particularly reported in young children, frequently presenting together with eye and joint complications, but respiratory involvement is usually absent. 17,18 Microscopically, a noncaseating epithelioid granulomatous pattern has been described in the upper dermis, frequently involving the perifollicular areas, with common extension to the subcutaneous border. [16][17][18] Indeed, the eruption pattern has been compared with that of lichen scrofulosorum, consisting of asymptomatic papules, usually follicular in distribution.…”

“…17,18 Microscopically, a noncaseating epithelioid granulomatous pattern has been described in the upper dermis, frequently involving the perifollicular areas, with common extension to the subcutaneous border. [16][17][18] Indeed, the eruption pattern has been compared with that of lichen scrofulosorum, consisting of asymptomatic papules, usually follicular in distribution. 18 In the present case, the patient showed a diffuse lichenoid eruption, clinically similar to that of the lichenoid sarcoidosis previously described in the literature, whereas the microscopic pattern of the granulomas was different and was exclusively localized in the upper half of the dermis in a bandlike pattern, obscuring the basal cell epidermal layer, with an irregular epidermal hyperplasia, necrotic keratinocytes, and distinctive round, homogenous eosinophilic bodies (cytoid bodies) within the epidermis.…”

“…[16][17][18][19][20][21][22] Clinically, the lichenoid type presents with multiple 1-to 3-mm, dome-shaped erythematous or skin-colored, slightly scaling maculopapules involving an extensive area of the skin. They occur singly or in groups, especially localized on the trunk, limbs, and face.…”

Cutaneous Sarcoidosis

“…This cutaneous presentation has been reported most often in children, can be localized or extensive, and can be eruptive in nature. [61][62][63][64] Verrucous sarcoidosis presents most often on the lower legs of African American men and clinically appears as warty papules and plaques with overlying thick scale (hyperkeratotic) (Fig. 9).…”

Skin manifestations of sarcoidosis

“…Lichenoid sarcoidosis is estimated to be present in 1-2% of cases of skin sarcoidosis [75] and has been described more often in children [76][77][78][79][80]. Clinically it presents with multiple, 1-3 mm, flat-topped or dome-shaped erythematous or skincoloured maculopapules that may involve extensive areas of the trunk, limbs and face.…”