Isolated Cutaneous Sarcoidosis: A New Insight into the Old Entity

Abstract

Cutaneous lesions are a part of common manifestation in multi-systemic sarcoidosis and skin involvement occurs in 20% to 35% of the patients with systemic disease. An exclusive cutaneous involvement is rare and it is reported in about 4%-5% of the patients of sarcoidosis. These lesions have been classified into specific and non-specific, depending on the presence of non-caseating granulomas, on histopathologic studies. In the present study, we are reporting two cases of isolated cutaneous sarcoidosis without systemic manifestations, which is a rare presentation. Sarcoidosis will continue to challenge even the most experienced clinicians with respect to a high degree of suspicion and further investigations for diagnosing and treating this disorder. CASE REPORT ONEA 57-years-old male presented with a raised erythematous lesion which measured 1.5x1.5 cm over the forehead. The lesion started as a papule and gradually progressed to the present size. There was no history of dyspnoea, prolonged fever or other systemic complaints. There was no significant family history which included that of tuberculosis. The haematological and biochemical investigations including angiotensin converting enzyme (ACE) levels, ESR, CRP, ANA and serum calcium showed normal values. The ophthalmological assessment was normal. CASE REPORT TWOA 38 year old male presented with a lesion which measured 2 x 1.5 cm over the elbow region, which was provisionally diagnosed as a neurofibroma. The biopsy showed well formed non caseating granulomas with asterioid bodies and Langhans giant cells and a histopathological diagnosis of sarcoidosis was offered. Further evaluation showed no organ involvement and no hilar lymphadenopathy.The patient showed no ocular involvement on ophthalmological assessment and other investigations were normal, including sputum for AFB culture. ACE levels were on higher side of the normal range.are misdiagnosed. The cutaneous lesions of Sarcoidosis assume a vast array of morphologies [2] and they are therefore considered as great mimickers in the dermatology practice. The specific types of lesions are lupus pernio, small and large nodules, small and large plaques and scar infiltrations. Lupus pernio is the most characteristic among the sarcoid skin lesions and it is seen as a chronic, persistent, bluish, indurated plaque with a predilection for nose and cheek, with nasal, mucosal and septal involvements [3].