Cutaneous sarcoidosis in Asians: a report of 25 patients from Singapore

Abstract

Sarcoidosis is a systemic noncaseating granulomatous disorder of unknown origin involving multiple organ systems. There has been no report so far to describe the epidemiological pattern of cutaneous involvement in sarcoidosis in South-East Asia with diverse ethnic groups. A retrospective study examining the clinicopathological features of all patients diagnosed with sarcoidosis at a tertiary dermatology centre in Singapore from 1980 to 2003 was conducted. Cutaneous sarcoidosis was diagnosed in 25 patients: 13 were Indian, 11 were Chinese and one was Eurasian. Cutaneous manifestations included papules, nodules, plaques and scarring alopecia. Extracutaneous involvement of lymph nodes (four patients), lungs (eight patients) and eyes (two patients) was seen. Eight patients had abnormal chest radiographic findings. Histopathological examination of skin lesions revealed noncaseating, epithelioid granulomatous infiltration in the dermis without evidence of mycobacterial infection, deep fungal infection or polarizable birefringent material. Treatment modalities included corticosteroids, hydroxychloroquine, isotretinoin, methotrexate and surgical excision. Five patients had complete resolution of the cutaneous lesions. Cutaneous sarcoidosis is rare in Asia and indeed in Singapore. Extracutaneous involvement is not uncommon and a thorough clinical evaluation should be undertaken.

Sarcoidose cutânea sobre cicatrizes: relato de caso

“…2,7 The involvement of the skin occurs in 25% of the cases and it can develop in any phase of the disease although it is more common at the beginning 8 .…”

The Immunological Association between Alopecia Areata and Respiratory Diseases: A Systematic Review

“…In 2 studies in Singaporean Asian and Black South African sarcoidosis patients ( n = 55), 3.33–4% of patients had AA while 10–32% had sarcoid-associated pulmonary disease [6, 7]. Evans syndrome (ES) is a rare hematological manifestation of autoimmune hemolytic anemia or immune thrombocytopenia in the presence of SLE.…”

“…Additionally, 9 studies (5 case-control and 4 cross-sectional) stratified patients based on the type of atopic respiratory disease (i.e., AR vs. asthma), and 7 studies (1 case-control and 6 cross-sectional) reported hair loss in patients with systemic disease with pulmonary manifestations (e.g., sarcoidosis [6, 7], mixed connective tissue disease [MCTD] [8], dermatomyositis [DM] [9], SLE [10, 11], and emphysema) [12]. …”

“…Patterns of alopecia have been associated with the severity of obstructive pulmonary disease, and multiple autoimmune diseases that manifest with pulmonary disease also demonstrate an association with AA including sarcoidosis, SLE, MCTD, and DM [6-11]. Immunologically, active MCTD, sarcoidosis, and SLE favor CD4+/interleukin (IL)-4/Th2 pathways, while AA is considered a Th1 disease state [33-35].…”

Sarcoidosis

“…Three patients relapsed within 3 months of apremilast discontinuation. 169 Anecdotal reports documenting improvement of cutaneous sarcoidosis with isotretinoin 189,190 and with allopurinol have been published. 191 Case reports have described improvement of steroidrefractory lung function during cyclosporine therapy but a randomized trial found no benefit as a steroid-sparing agent and increased complications.…”