some keratosis and irregularity to the epidermis, underneath is the lesion Image

large back to back epithelioid granulomas, some multinucleated cells, invested in collagen Image

Sarcoid can affect any organ, with a preference for the lungs, eyes, lymph nodes and skin. Skin involvement occurs in between 20% to 35% of patients with systemic disease but may also occur by itself.

I copied this so it needs to be modified: ERYTHEMA NODOSUM

Sarcoidosis is only one of many causes of erythema nodosum, which is thought

to be a reactive phenomenon. Typically ill-defined tender, red nodules arise on

the limbs and resolve over 2 to 3 weeks with characteristic bruising (figure 1).

Erythema nodosum is classically seen in young women as a marker of acute

sarcoidosis.6 It is often seen in association with arthralgia, general malaise and

bilateral hilar lymphadenopathy on chest X-ray.

MACULOPAPULAR SARCOIDOSIS

Lesions arise as asymptomatic macules and papules ranging in colour from redbrown

to purple and in size up to 5 mm (figure 2). The commonest areas of

involvement are the face and extensor aspects of the limbs. Spontaneous resolution

may occur with or without atrophic scarring.

NODULAR SARCOIDOSIS

This form predominantly affects the proximal limbs and face. It is characterised

by the development of well-circumscribed nodules measuring more than 5 mm

across (figure 3). Again, the colour may vary from red-brown to violaceous and

there may be surface telangiectasia. Lesions tend to be indolent.

ANNULAR SARCOIDOSIS

Annular forms of cutaneous sarcoidosis are well recognised.7 Lesions of maculopapular

sarcoidosis often show annular formations. A more severe variant,

often occurring on the face and resembling necrobiosis lipoidica, is also seen.

Disfiguring circinate lesions arise with a leading granulomatous edge and a central

atrophic area with telangiectasia (figure 4). This form tends to be persistent.

SCAR SARCOIDOSIS

Granulomatous infiltration of scars by sarcoidal tissue may occur in a number of

situations, eg, surgical scars, at vaccination sites, and in tattoos.8 Scars become

infiltrated and inflamed with a violaceous colouration (figure 5). Scar sarcoidosis

activity may parallel systemic disease behaviour,5 but may also occur in isolation.

LUPUS PERNIO

This is more common in older patients and women.9 The face and nose are usually

involved with the development of infiltrated blue-red plaques and nodules

(figure 6). Lupus pernio is usually associated with chronic sarcoidosis, especially

involvement of the upper respiratory tract, lacrimal glands and bone. The

cosmetic effects of lupus pernio may be severe and lead to considerable psychological

distress.

PLAQUE SARCOIDOSIS

This indolent form of the disease usually involves the limbs with diffuse plaques. Again, these lesions may show similar features to the atrophic plaques

of necrobiosis lipoidica.

RARE FORMS

Other manifestations of cutaneous sarcoidosis which have been described

include nail involvement (figure 8) and angiolupoid, ulcerative, subcutaneous,

icthyosiform, psoriasiform, and lichenoid forms.

With the exception of erythema nodosum and maculopapular sarcoidosis, most

of the types of cutaneous sarcoidosis are chronic.

• Lung : Sarcoidosis

• Lymph Nodes : Sarcoidosis

• Lymph Nodes : Sarcoidosis