Dermatology-Online

Sarcoid of the skin

Definition - what is sarcoid of the skin?

Sarcoid is an inflammatory disease that can affect various organs. Sarcoid can be acute or chronic. The lungs are most commonly affected. In addition, about 30% of the skin is also frequently affected.

Sarcoid of the skin is associated with characteristic skin changes, the so-called erythema nodosum. Those affected suffer from initially red, later bluish lumps under the skin.

Symptoms of sarcoid skin disease

In the acute form of sarcoid skin, those affected suffer from erythema nodosum. The term erythema means inflammatory reddening and the word nodosum describes the nodular skin changes. Erythema nodosum typically consists of initially reddish and later bluish lumps under the skin.

The nodes can be large or small and have a diameter of 1 to 10 centimeters. The nodular changes are often found in the face, arms, legs, trunk and mucous membranes. The most common location is in the area of the extensor sides of the lower legs.

In the acute form of sarcoid, arthritis and biliary lymphadenopathy are often present in addition to erythema nodosum of the skin. The chronic form of sarcoid skin is also associated with nodular skin changes. The skin can have large, small, subcutaneous, nodular or ring-shaped changes. The large-nodular changes are typically associated with telangiectasias, visible bluish vascular dilatations.

If erythema occurs especially on the face, one speaks of lupus pernio.You can see reddish-blue, shiny nodules. These are mainly found on the nose, cheeks and earlobes.

Itching in skin sarcoid

Itching is a discomfort to the skin that makes it want to scratch and rub. Itching is not a classic symptom of sarcoid skin. However, people may experience severe itching all over their bodies.

Skin sarcoid scars

In the early sarcoid stage or in chronic sarcoid, skin changes occur in the area of old scars. At first there are yellowish-reddish changes and then brownish-reddish changes in the area of the old scars.

Skin changes in skin sarcoid

Sarcoid of the skin is associated with various possible skin changes. The acute form of sarcoid appears with erythema nodosum, which often regresses after a few months. Erythema nodosum consists of nodular changes in the skin, which are usually initially reddish in color and very tender on pressure.

There are both large and small nodules in chronic skin sarcoid. Over time, the small-nodular changes in the skin often lead to hyperpigmentation of the affected areas and the development of telangiectasias. Telangiectasias are vasodilatations that can be seen bluish under the surface of the skin.

Erythema nodosum

The erythema is an inflammation of the subcutaneous fatty tissue and occurs as part of a hypersensitivity reaction. In addition to sarcoid of the skin, erythema nodosum can be triggered by various autoimmune diseases and bacterial infections.

Erythema nodosum is found on the face, on the arms, legs, on the trunk and on the mucous membranes. The erythema is most commonly seen on the extensor sides of the lower legs.

The skin inflammation shows reddish, nodular areas. The nodes can be 1 to 10 centimeters in size and turn bluish as they progress. The erythema usually heals spontaneously within a few weeks to months.

Therapy of sarcoid of the skin

Not every sarcoid is in need of treatment. 95% of acute sarcoid diseases heal spontaneously within a few months, even without treatment.

If the symptoms are severe, acute sarcoidosis of the skin can be treated with anti-inflammatory drugs, for example acetylsalicylic acid (Aspirin®) or ibuprofen.

Cortisone is used for major complaints. Chronic sarcoid of the skin is usually treated with cortisone over a period of several months.

Very severe cases of sarcoidosis are treated with immunosuppressants. Examples are methotrexate, azathioprine and chloroquine.

Duration vs. Prognosis of sarcoid of the skin

In sarcoid skin disease, more than 60% of cases heal spontaneously within two to five years. The disease progresses only in 10 to 30% of the sick.

In the case of special forms such as lupus pernio, about 50% of the cases heal spontaneously. Unfortunately, even after the skin has healed completely, sarcoidosis can keep coming back.

Course of the disease of skin sarcoid

The acute form of sarcoid heals spontaneously in 95% of patients within months. Fortunately, more than half of all sarcoid cases heal within two to five years. The disease progresses in around 10 to 30% of cases.

Overall, the nodular skin changes heal better than the special form of lupus pernio. In the case of sarcoid, the prognosis depends on the lung findings.

Causes of sarcoid of the skin

Sarcoid is a multisystem inflammatory disease with no known cause. There is certainly an association with certain HLA antigens, which is why scientists assume a genetic predisposition for the development of sarcoid.

At the same time, a connection with environmental factors determines. This includes work in the metalworking industry as well as work in agriculture.

Diagnosis of sarcoid of the skin

Since sarcoid of the skin causes characteristic symptoms, those affected usually see a doctor early. The family doctor can get a first impression and, depending on accompanying complaints, initiate further examinations if necessary.

Typically, you will be referred to a dermatologist. The dermatologist usually takes biopsies and tissue samples and examines them microscopically.

Skin sarcoid biopsy

The dermatologist takes a skin biopsy to confirm the diagnosis if sarcoid is suspected of the skin. To do this, the skin area to be examined is first numbed and disinfected and then cut out with a scalpel. The removed biopsy is then examined under the microscope.

You can read more information on this topic here: Skin biopsy