Generalized Atrophic Sarcoidosis With Ulcerations

Abstract

A 53-year-old man presented to the Manhattan (NY) Veterans Administration Hospital with a 20-year history of generalized atrophic lesions associated with lower extremity ulcerations. Cutaneous biopsy specimens and other laboratory data confirmed the diagnosis of sarcoidosis involving the skin, lungs, eyes, joints, bones, pituitary gland, gonads, and liver. To our knowledge, generalized atrophic sarcoidal lesions have not been described previously in the English literature. Ulcerated cutaneous sarcoidal lesions, though recognized, are only rarely seen in the disease. The ulcerations, but not the atrophic lesions, responded to prednisone therapy.

Generalized atrophic plaques in a young male

“…The atrophic form of sarcoidosis is usually resistant to treatment, although coexisting ulcerative lesions tend to heal with treatment using corticosteroids and other immunosuppressants/immunomodulators . Findings in the present patient support the notion that, like syphilis, sarcoidosis is a “great imitator” and that strong clinical suspicion is essential for its diagnosis.…”

“…Rare presentations include psoriasiform, hypopigmentation, ichthyosiform, erythroderma, lower limb edema, and atrophic and ulcerative forms . The atrophic form of sarcoidosis is uncommon and usually coexists with ulcerative lesions; hence, both are considered to be on the same spectrum . Trauma to atrophic sarcoidal lesions has been implicated as a factor contributing to the development of ulcers .…”

Sarcoidosis Can Present with Necrotizing Granulomas Histologically: Two Cases of Ulcerated Sarcoidosis and Review of the Literature

“…14,15,46 However, ulcerative sarcoidosis is often resistant to other treatment modalities: treatment failures have been reported with the use of topical and intralesional triamcinolone, antimicrobials, allopurinol, isotretinoin, chloroquine, radiation therapy, and surgical approaches. 14,19,[47][48][49] To our knowledge, cyclosporine use has not been reported in the treatment of ulcerative sarcoidosis.…”

Clinicopathologic features of ulcerative‐atrophic sarcoidosis

“…Ulcerative sarcoidosis is resistant to treatment. Treatment failures have been shown with the use of chloroquine, as well as both topical and intralesional triamcinolone, 17 isotretinoin, antimicrobials, allopurinol, 18 radiation therapy, antimalarials, and other topical therapy 12,19 ,20 . Various surgical approaches have also been attempted with little success.…”