Cutaneous Sarcoidosis and Tribal Scarifications in West Africa

Abstract

Sarcoidosis is quite common in American and West Indian blacks. In America, the incidence in blacks could be up to 10 times higher than in whites. Sarcoidosis is generally believed to be rarer in African blacks and especially along the West African coast from which the American blacks trace their ancestry. The difference in incidence may be due to environmental influences, poor reporting system from inadequate local awareness of the presentation, confusion with tuberculosis, and lack of the Kveim antigen. Diagnosis of sarcoidosis is most commonly made from the pulmonary and skin manifestations. Since the skin manifestation presents readily for observation without the need for costly devices like x-ray machines, the present study focused on and analyzed the seven cases seen in the skin clinic within a period of 2 years (an incidence of 0.85%), showing that the commonest presentation was as scar-sarcoid on longstanding tribal marks. Tribal scarification is common in West Africa, and one should investigate any change in a longstanding scar. This heightened awareness in areas where scarification is or was practiced could end the belief of the rarity of sarcoidosis in the West African subregion.

Multisystemic diseases and ethnicity: a focus on lupus erythematosus, systemic sclerosis, sarcoidosis and Behçet disease

“…12a,b). 49 One or several old skin scars that may have been present for decades, suddenly becomes thicker and infiltrated. Biopsy shows a noncaseating granuloma that could suggest sarcoidosis or a foreign-body reaction, e.g.…”

Clinical Images: Recurrence of sarcoidosis heralded by Bullous reaction within tribal scarification

“…Sarcoid granulomatous reaction can develop in tattooed areas of the skin; the first case reported was of an American soldier in 1952 (1). Similar dermatologic symptoms have been described in marks of scarification, a common practice in sub-Saharan cultures (2,3). The typical skin lesions in tattoos and tribal marks may facilitate the diagnosis of sarcoidosis in some cases when the diagnosis is difficult because of the clinical heterogeneity of the disease.…”

Subcutaneous lymphoid hyperplasia arising at site of ethnic scarifications and mimicking subcutaneous panniculitis-like T-cell lymphoma

“…Since both cashew nut and plants belonging to the Euphorbiacae species contain substances with strong immune properties [9,13], we can conceive that all of the aforementioned histological changes found in this patient are the consequence of a delayed persistent immunisation reac-301 tion to one or several of these immunostimulating compounds, introduced at the time of the scarification process. This speculative assumption is in other respects supported by the description of hypertrophic lesions that arise several years later on areas with scarifications [1].…”