Sarcoidosis con compromiso cutáneo casuística del Servicio de Dermatología del Hospital Nacional- período 2010-2020 / Sarcoidosis with skin engagement casuistics of the National Hospital Dermatology Service - period 2010-2020

Introducción: La sarcoidosis es una enfermedad inflamatoria, granulomatosa de etiología desconocida. Puede afectar cualquier órgano siendo la afectación pulmonar la más frecuente. La piel se compromete en aproximadamente 30% de los casos, pudiendo ser inicial o único. La sarcoidosis es muy rara en el Paraguay. Objetivos: Realizar una revisión de los casos de sarcoidosis observados en el Servicio de Dermatología del Hospital Nacional en el periodo 2010-2020; determinando sus características demográficas, clínicas, laboratoriales y evolutivas. Materiales y métodos: Estudio retrospectivo, descriptivo y observacional. Resultados: Se diagnosticaron 5 casos, todas mujeres de raza blanca, con edades que oscilaban de 41 a 63 años. Las formas clínicas fueron papulosa en 3 casos, en placa 1 y mixta 1. Las lesiones cutáneas eran asintomáticas y estaban ubicadas preferentemente en rostro (4 casos). El compromiso sistémico se objetivó en las primeras consultas en 2 casos (pulmonar, ocular y ganglionar en 1 y del aparato lagrimal en otro). En todos los casos el diagnóstico se fundamentó en la correlación clínico-histológica, con el hallazgo de los granulomas sarcoides. Todos recibieron clobetasol tópico, 3 pacientes ciclos de prednisona y 2 hidroxicloroquina. La evolución fue favorable en 3 casos y 2 no volvieron a sus controles. Conclusión: La sarcoidosis con manifestaciones cutáneas es rara en nuestro Servicio, pero representa un desafío diagnóstico, que debe ser oportuno para diferenciarla de otras patologías más prevalentes en nuestro medio

Introduction: Sarcoidosis is an inflammatory, granulomatous disease of unknown etiology. It can affect any organ, lung involvement being the most frequent. The skin is compromised in approximately 30% of the cases, and can be initial or unique. Sarcoidosis is very rare in Paraguay. Objectives: To carry out a review of the sarcoidosis cases observed in the Dermatology Service of the National Hospital in the period 2010-2020; determining their demographic, clinical, laboratory and evolutionary characteristics. Materials and methods: Retrospective, descriptive and observational study. Results: 5 cases were diagnosed; all white women; with ages ranging from 41 to 63 years. The clinical forms were papular in 3 cases, in plate 1 and mixed 1. The skin lesions were asymptomatic and were preferably located on the face (4 cases). Systemic involvement was observed in the first consultations in 2 cases (pulmonary, ocular and lymph node in 1 and the lacrimal apparatus in another). In all cases the diagnosis was based on the clinical-histological correlation, with the finding of sarcoid granulomas. All received topical clobetasol, 3 patients received prednisone cycles and 2 hydroxychloroquine. The evolution was favorable in 3 cases and 2 did not return to their controls. Conclusion: Sarcoidosis with skin manifestations is rare in our Service, but it represents a diagnostic challenge that must be timely to differentiate it from other more prevalent pathologies in our setting

Buena respuesta a tratamiento con triamcinolona en Sarcoidosis Cutánea / Good response to treatment with triamcinolone in Cutaneous Sarcoidosis

RESUMEN La sarcoidosis es una enfermedad granulomatosa multisistémica, de etiología desconocida y evolución crónicaque afecta con mayor frecuencia los pulmones, los ojos y la piel. Aproximadamente un 25% de los pacientes presentan como única manifestación la forma cutánea. Se presenta el caso clínico de una paciente con diagnósticode sarcoidosis cutánea, a quien se le realizó tratamiento con infiltraciones de triamcinolona obteniendo muy buena respuesta. Se realiza unarevisión de la literatura.

ABSTRACT Sarcoidosis is a multisystemic granulomatous disease of unknown etiology with chronic evolution the most frequently affectes the lungs, eyes and skin. Approximately 25% of patients present as the only manifestation the cutaneous form. We present the clinical case of a patient diagnosed with cutaneous sarcoidosis, who underwent treatment with triamcinolone infiltrations, obtaining a very good response. Areview of the literatureisalso carried out.

Sarcoidosis detected due to tattoo swellings in an Indian female.

A female patient presented with asymptomatic swellings in old blue-black tattoo marks of her forearms. On careful skin examination, few raised erythematous, circular plaques were also found on the non-tattooed skin on her back, about which she was unaware. The diagnosis of cutaneous and systemic sarcoidosis was confi rmed after classical histopathological fi ndings from skin lesions from her non tattooed back and from papulonodular tattooed lesions, ruling out other causes of granulomas and supported by a negative Mantoux test, raised serum angiotensin converting enzyme level, high resolution computed tomography thorax, etc. She responded well to oral steroid therapy. The importance of a careful skin examination, easy access provided by skin lesions in suspected cases of cutaneous/systemic sarcoidosis, the value of sudden tattoo changes in the diagnosis here and the possible contribution of tattoos toward the causation of cutaneous and/or systemic sarcoidosis are highlighted.

Sarcoidosis cutánea / Cutaneous sarcoidosis

Presentamos el caso de una paciente de sexo femenino, de 50 años de edad, quien desarrolló sarcoidosis cutánea pura, sin hallazgos hasta la fecha de compromiso sistémico, demostrando buena respuesta al tratamiento con córticoesteroides sistémicos.

We report the case of a female patient, aged 50, who developed cutaneous sarcoidosis pure, without finding so far, systemic involvement, demonstrating good response to treatment with systemic corticosteroids.

Clinical Observation of Cutaneous Sarcoidosis / 대한피부과학회지

BACKGROUND: Sarcoidosis is a chronic idiopathic disorder characterized by the formation of noncaseating granulomas. Multiple organs may be involved, including the skin, lung, lymphatic systems, liver, spleen and eyes. On average, 25% of sarcoidosis cases have cutaneous involvement. OBJECTIVE: The purpose of this study was to investigate the clinical characteristics of cutaneous sarcoidosis and the involvement of systemic organs according to clinical types of skin lesions. METHODS: A total of 32 patients diagnosed by histologic examination at Hospital from 2001 to 2009 with cutaneous sarcoidosis were enrolled in this study. The clinical features were obtained by reviewing medical records, clinical photographs and radiological images. RESULTS: The male to female ratio was 1 : 3 and 78.2% of patients were in their fifth to seventh decades. The most common cutaenous lesions were nodules (56.3%), especially the subcutaneous type (21.9%). The most frequently involved organ type was intrathoracic (71.9%), followed by the peripheral lymph nodes (25%), spleen (6.3%), and eyes (6.3%). Most patients with subcutaneous nodules, erythema nodosa, lupus pernio and discoid lupus-like plaques showed systemic involvement, whereas most patients with nodules or papules did not show systemic involvement. Of particular note, patients with subcutaneous nodules and lupus pernio showed more frequent involvement of the peripheral lymph nodes, spleen and intrathoracic region. CONCLUSION: In this study, patients with subcutaneous nodules and plaques showed more frequent systemic involvement, while most patients with nodules or papules showed no systemic involvement.

Cutaneous Sarcoidosis Presenting as Multiple Erythematous Macules and Patches

Sarcoidosis is an idiopathic multisystemic disorder with variable cutaneous presentations that are classified as specific or non-specific according to the presence of non-caseating granulomas on histologic examination. Specific manifestations can include papules, scar sarcoidosis, ulcers, or even alopecia. Herein, we present a case of cutaneous sarcoidosis that presented as multiple erythematous macules and patches on the trunk and extremities of a 32-year-old man. The clinical appearance was unlike any other form reported in the literature.

A Case of Micropapular Sarcoidosis / 대한피부과학회지

Cutaneous sarcoidosis occurs in 20-25% of systemic sarcoidosis and can be presented without other organ involvement. Most frequent clinical features are maculopapule, nodule, plaque, subcutaneous nodule, infiltrative scar and lupus pernio, but uncommon forms including ulcer, alopecia, hypopigmented and micropapular type have been described. Micropapular type is a rare form of cutaneous sarcoidosis with good prognosis. We present a case of generalized micropapular sarcoidosis without other organ involvement.

Seven Cases of Cutaneous Sarcoidosis / 대한피부과학회지

We report seven cases of cutaneous sarcoidosis without systemic involvement. All cases showed specific skin lesions which were papules (2 cases), patches (2 cases), subcutaneous nodules (2 cases) and plaques (1 case), respectively. Histologic examinations of the specimens commonly showed typical noncaseating granulomas. Although we performed the various laboratory studies, there was no evidence of systemic involvement in any case. Treatment with intralesional and/or topical steroid resulted in good responses, but we experienced some relapses of the skin lesions after withdrawal of treatment. Excision was the choice of treatment for subcutanous nodules. During the follow-up periods (1 - 4 years), we could not find any evidence of systemic involvement. Our cases represent the unusual cases of cutaneous sarcoidosis without systemic involvement.

A Clinical and Pathological Study of Sarcoidosis / 대한피부과학회지

BACKGROUND: The occurane of sarcoidosis seems to be increased recently. A proportion of patients initiallly visit the derrnatological department. However, there are few clinical reports about sarcoidosis for the dermatolagist. OBJECTIVE: This study wa performed to find the clinical and histopathological characteristis of sarcoidosis as a multisystemic disease. METHODS: We reviwed the chart of patients with sarcoidosis who were diagnosed at SNUH from 1984 to 1994 and analysed the characteristics of the clinical and histopathologic findings according to several factors. RESULTS: 1)Man to woman ratio was 1: 2 and 70% of patients were in theirs third to fifth decades. 2)The main complaints were respiratory symtoms and cutaneous lesion. 3)The most frequently invloved organ was intrathoracic, followed by skin, peripheral lymph node, eye and bone in that order. 4)The cutaneous lesion was found in 50% of patients(15 out of 30) and specitic lesions were present in 14 cases. A subcitaneous nodule was the most common lesion(67%). 5)In subcutaenous sarcoicosis, there was hilar lymphadenopathy in 70% of the patients, lung parenchymal infiltration in 10%, peripheral lymphadenopathy in 30%, bony lesion in 30%. 6)The laboratory and histopathological findings were similar to previously reported results. CONCLUSION: The general features of patients were similar to other reports except for the fre quency of cutaneous involviment. Cutaneous involvement was found in 50% of patients and this was higher than in foreigr reports. In cutaneous sarcoidosis, the subcutaneous nodule was the most frequent specific lesior.