Cutaneous sarcoidosis treated with methotrexate

Sixteen patients with cutaneous sarcoidosis, 15 of whom also had involvement of other organs, were treated with methotrexate (MTX) orally once a week in an open study. The treatment period was from 1 to 72 months (mean 23 months). In 12 patients the skin lesions cleared, and in 3 of 4 patients who had sarcoid uveitis this cleared as well. The chest X-ray of 6 patients showed no corresponding improvement in pulmonary changes or in hilar adenopathy. Ten patients suffered side effects, usually nausea on the day MTX was taken. Two had transiently increased transaminase levels. Treatment was discontinued in 2 patients due to nausea. It is concluded that MTX is a useful alternative to systemically administered glucocorticoids in the treatment of disfiguring cutaneous sarcoidosis and sarcoid uveitis. The effect of MTX on hilar adenopathy and pulmonary sarcoidosis is uncertain.     

Cutaneous sarcoidosis successfully treated with alefacept

BACKGROUND: Sarcoidosis is a systemic granulomatous disease of unknown etiology that affects multiple organ systems, including the pulmonary, lymphatic, skeletal, and integumentary systems. Improved understanding of the intrinsic immunology and molecular biology in sarcoidosis can be applied to the treatment of this disease. Alefacept is a human fusion protein consisting of the extracellular domain of leukocyte function-associated antigen 3 fused with the Fc portion of human immunoglobulin G1. It works by blocking the interaction between antigen-presenting cells and T cells to inhibit activation and by inducing apoptosis of CD4+ T cells. In this case report, we describe a 46-year-old patient with recalcitrant lupus pernio who was successfully treated with alefacept. OBJECTIVE: To determine whether T-cell inhibition, specifically the use of alefacept, may be used to treat a patient with recalcitrant cutaneous sarcoidosis. METHODS: Case report. RESULTS: There was a modest clinical improvement after 8 weeks of intramuscular injections of alefacept. CONCLUSION: This case report provides further evidence of successful treatment of sarcoidosis with biologic agents directed against T-lymphocyte activation.     

Cutaneous sarcoidosis successfully treated with topical tacrolimus

Sarcoidosis is a disorder characterized by macrophage- and T-cell-mediated responses to as yet unidentified infectious antigens or autoantigens. We describe a 62-year-old woman with a 10-year history of orange-yellow plaques of sarcoidosis on her face. Her cutaneous lesions responded to topical tacrolimus ointment after unsuccessful treatment with topical and systemic corticosteroids. No adverse effects were noted with topical tacrolimus in this patient. We discuss the mode of action by which this immunosuppressive agent may act against sarcoidosis.     

Cutaneous sarcoidosis with cardiac involvement.

Despite the clinical importance of cardiac involvement in the prognosis of sarcoidosis, it is often overlooked because of the subclinical disease progression and difficulty in diagnosis. We report here five patients with cutaneous sarcoidosis lesions where cardiac involvement was detected with the appearance of mild cardiac symptoms on a careful examination of the heart after cutaneous sarcoidosis was diagnosed. In four of the five cases, the patients had annular lesions while the fifth case showed a nodular eruption on the face. Three of the five patients showed complete AV block while one showed complete right bundle block and left bundle anterior branch block. All four patients with conduction disturbances underwent a permanent pacemaker implantation with prednisolone tapering therapy. The remaining patient had congestive heart failure and was treated with prednisolone alone. The present findings support the belief that sarcoidosis patients with cutaneous lesions, especially facial annular lesions, should be carefully examined and monitored for cardiac involvement, even in cases without apparent cardiac symptoms.     

Cutaneous sarcoidosis

We report on three clinical cases of cutaneous sarcoidosis. One of them was associated with erythema nodosum, another with erythema annulare centrifugum. The third case showed an annular lesion having persisted for 10 years; X-ray of the lungs revealed stage 3 disease.     

Cutaneous sarcoidosis

Cutaneous sarcoidosis in a middle aged lady is reported. Though sarcoidosis is rare in our country, an awarenesss about this condition is required to prevent misdiagnosis.     

Cutaneous sarcoidosis with tuberculoid granuloma

Cutaneous sarcoidosis is not an uncommon clinical entity. We report a case of cutaneous sarcoidosis, the histology of which showed tuberculoid granuloma.     

Ulcerative sarcoidosis successfully treated with apligraf.

The case of a 73-year-old female patient is reported with a 25-year-long history of widespread cutaneous sarcoidosis without any known extracutaneous manifestations. The skin manifestations started with erythematous and plaque-like lesions that had ulcerated on the legs for the last half-year. A relevant venous insufficiency or other etiology of the ulcers could not be found. Histology from lesions of the trunk and from the surroundings of the ulcers revealed the typical noncaseating granulomas. A systemic involvement could not be observed; leukopenia and a slightly elevated angiotensin-converting enzyme level in the serum were found. Topical steroids did not prove successful on the ulcers. Apligraf, a bilayered skin equivalent, was transplanted twice on the ulcers leading to complete closure within 3 months. A therapy with systemic steroids could thus be avoided.     

Cutaneous nodular sarcoidosis with granulomatous renal sarcoid

We describe a 66-year-old lady who presented with tender nodules on her trunk and limbs which were histologically proved to be sarcoid. Following steroid therapy the skin lesions remitted, but renal failure developed due to a severe granulomatous interstitial nephritis. Clinical and biochemical improvement followed treatment with high dose steroids, although renal function and renal biopsy remained abnormal.     

Cutaneous sarcoidosis in Nigeria

The study is a retrospective analysis of the cutaneous manifestations of sarcoidosis in patients seen during a 10-year period at the skin and chest clinics of the Lagos University Teaching Hospital. Of the 43 patients with sarcoidosis 30% had skin lesions. The most common was sarcoidal infiltration of scarification marks. Facial macropapular lesions also were frequently present.     

Cutaneous sarcoidosis therapy updated

The widely accepted standard therapy for cutaneous sarcoidosis includes corticosteroids, antimalarials, and methotrexate. However, a better understanding of the basic immunopathogenic properties of sarcoidosis has elucidated a number of steps critical to the persistence and progression of disease that may be vulnerable to treatment by targeted therapy. This article reviews both standard and newer therapeutic options for cutaneous sarcoidosis.     

Cutaneous ulcers in sarcoidosis

We treated four patients with multisystem sarcoidosis and skin ulceration. Their cases are compared with those of patients previously described in the literature. Treatment for ulcerative sarcoid is also discussed.