Sarcoidosis, a multisystemic disease of unknown etiology, may involve virtually any organ in the body, including the lungs, lymph nodes, liver, spleen, eyes, etc. [1] [2] [3]. In approximately 25-35% of patients, it can cause skin-related symptoms, in which case the term cutaneous sarcoidosis is used [3] [4] [5]. Furthermore, reports show that cutaneous signs of the disease are the only manifestation in 3-5% of patients [4] [5]. Numerous skin lesions have been reported in the literature, but the two most common and most important are [3] [6]:

• Erythema nodosum - Despite its nonspecific nature (may be seen in drug-induced, infection-related, or inflammation-induced hypersensitivity reactions as well), the sudden appearance of erythematous nodules in the subcutaneous tissues of the anterior tibia is a rather common cutaneous sign of sarcoidosis [6]. The nodules are very tender on palpation and are often accompanied by fever, joint pain, and malaise [6].
• Lupus pernio - The presence of purple-to-red indurated papules, plaques, or nodules on the face (the alar rim of the nose and surrounding area) is a more specific feature of cutaneous sarcoidosis, and is more frequently seen in women [3] [6]. Telangiectasias can also develop together with lupus pernio [5].

In addition to erythema nodosum and lupus pernio, single or multiple papules or plaques of different sizes and colors (red, brown, hypopigmented or even translucent) developing on the face and the extremities, either as isolated lesions or in a confluent pattern are other notable manifestations of this disease [2] [6]. In some cases, the term is used to denote the appearance of the lesion in a preexisting scar (scar sarcoidosis) [6].

• Pain

  However, for some patients, skin lesions may be painful and may result in the skin becoming damaged or scarred. [sarcoidosisnews.com]

  […] can include: dry eyes itchy eyes eye pain vision loss a burning sensation in your eyes a discharge from your eyes It can be difficult to diagnose sarcoidosis. [healthline.com]

  General symptoms Sarcoidosis can begin with these signs and symptoms: Fatigue Swollen lymph nodes Weight loss Pain and swelling in joints, such as the ankles Lung symptoms Sarcoidosis most often affects the lungs and may cause lung problems, such as: [mayoclinic.org]

  Recently, a 27-year-old male presented with multiple pink papules on the flank and lower back, accompanied by a painful, burning sensation. [ncbi.nlm.nih.gov]

• Asymptomatic

  We report the case of a patient with rheumatoid arthritis who, after 2 months of treatment with etanercept, showed disseminated asymptomatic violaceous papules. [ncbi.nlm.nih.gov]

  Asymptomatic patients with bilateral hilar adenopathy may not need systemic steroid therapy. [jnsbm.org]

  CS with multisystemic involvement is treated with topical steroids or systemic corticosteroids.5 Asymptomatic patients with isolated lesions may not need systemic corticosteroids, but should continue to be monitored. [archbronconeumol.org]

• Lymphadenopathy

  Computed tomography revealed bilateral hilar and mediastinal lymphadenopathy. Ophthalmological examination showed elevated intraocular pressure. [ncbi.nlm.nih.gov]

  Computed tomography of the chest with and without contrast showed no evidence of active pulmonary sarcoidosis or lymphadenopathy. [jddonline.com]

  The adenopathy may be unilateral or bilateral hilar and/or right paratracheal lymphadenopathy. Other symptoms include anterior uveitis, fever, ankle periarthritis, arthralgias, and pulmonary involvement. [emedicine.medscape.com]

  Our patient though found having mediastinal lymphadenopathy, did not show abdominal lymphadenopathy probably due to early stage of the disease and appeared to be nonprogressive during the year of follow-up. [ijdvl.com]

  Patients with early disease (hilar lymphadenopathy only) often do not require any therapy. [patient.info]

• Fatigue

  When it affects the whole body, it generates such symptoms as fatigue, fever, and weight loss. [sarcoidosisnews.com]

  If you have symptoms, they may include Cough Shortness of breath Weight loss Night sweats Fatigue Tests to diagnose sarcoidosis include chest x-rays, lung function tests, and a biopsy. Not everyone who has the disease needs treatment. [icdlist.com]

  General symptoms Sarcoidosis can begin with these signs and symptoms: Fatigue Swollen lymph nodes Weight loss Pain and swelling in joints, such as the ankles Lung symptoms Sarcoidosis most often affects the lungs and may cause lung problems, such as: [mayoclinic.org]

  Mea - suring fatigue in sarcoidosis: The Fatigue Assessment Scale (FAS). British Journal of Health Psychology 2004; 9: 279-91. 30. Chang JA, Curtis JR, Patrick DL, et al. [content.sciendo.com]

  Fatigue in patients with inactive sarcoidosis does not correlate with lung ventilation ability or walking distance. Pilot Study. Pneumonol Alergol Pol. 2015;83 (1):14-22. DOI: 10.5603/PiAP.2015.0002.CrossrefGoogle Scholar 17. [degruyter.com]

• Congestive Heart Failure

  heart failure, pericarditis or papillary muscle dysfunction (valvular heart disease). [dermnetnz.org]

• Dry Cough

  Lung symptoms can include: a dry cough shortness of breath wheezing chest pain around your breastbone Skin symptoms can include: skin rashes skin sores hair loss raised scars Nervous system symptoms can include: seizures hearing loss headaches Eye symptoms [healthline.com]

  cough Shortness of breath Wheezing Chest pain Skin symptoms Sarcoidosis may cause skin problems, which may include: A rash of red or reddish-purple bumps, usually located on the shins or ankles, which may be warm and tender to the touch Disfiguring sores [mayoclinic.org]

  The main symptoms are shortness of breath and a persistent dry cough. Some people with pulmonary sarcoidosis experience pain and discomfort in their chest, but this is uncommon. [nhs.uk]

  Patients may present with dry cough, fever and dyspnoea accompanied by chest discomfort. Skin This is commonly affected. Sarcoidosis may cause a diverse variety of skin manifestations and may resemble both common and rare cutaneous diseases [ 7 ]. [patient.info]

  Fifty-four patients (45%) had dry, cough, dyspnea and chest discomfort while 32 patients (26.6%) had systemic symptoms like fever, fatigue, malaise, arthralgia and the remaining 16 patients (13.3%) had specific organ related symptoms. [mrmjournal.biomedcentral.com]

• Sputum

  PCR analysis for Mycobacterium tuberculosis in sputum sample was also negative, as well as three times repeated urine cultivation on Loewenstein. [cyberleninka.org]

  Sputum or bronchial lavage culture was done to exclude infection. [mrmjournal.biomedcentral.com]

  […] enzyme blood levels are used in the monitoring of sarcoidosis. [90] A bronchoalveolar lavage can show an elevated (of at least 3.5) CD4/CD8 T cell ratio, which is indicative (but not proof) of pulmonary sarcoidosis. [24] In at least one study the induced sputum [en.wikipedia.org]

• Respiratory Insufficiency

  Four patients died of respiratory insufficiency and 5 patients died of sudden heart attack. Discussion Sarcoidosis is a systemic granulomatous disease of unknown origin that can affect any organ in the body. [mrmjournal.biomedcentral.com]

• Jaundice

  Jaundice is rare. [18] [26] Blood [ edit ] Abnormal blood tests are frequent, accounting for over 50% of cases, but are not diagnostic. [26] [29] Lymphopenia is the most common blood anomaly in sarcoidosis. [26] Anemia occurs in about 20% of people with [en.wikipedia.org]

• Hypertension

  hypertension have essential hypertension. [verywellhealth.com]

  Wildly fluctuating blood pressure readings are characteristic of labile hypertension According to the Canadian Hypertension Society Consensus guidelines, labile hypertension, also known as borderline hypertension, is a variation of hypertension where [drtytus.com]

  This form of labile hypertension is often called “white coat hypertension” or “white coat syndrome.” Not everyone will have physical symptoms of labile hypertension. [healthline.com]

• Palpitations

  In these cases, beta-blockers are not used to lower blood pressure, but rather to reduce the symptoms associated with these conditions such as flushing, palpitations, or headaches. They’re often used in combination with anti-anxiety treatments. [healthline.com]

• Chest Pain

  These include shortness of breath, ankle swelling, irregular heart beat and chest pain. [dermnetnz.org]

  Persistent dry cough Shortness of breath Wheezing Chest pain Skin symptoms Sarcoidosis may cause skin problems, which may include: A rash of red or reddish-purple bumps, usually located on the shins or ankles, which may be warm and tender to the touch [mayoclinic.org]

  In some cases, there are no symptoms, with the disease showing up in a chest X-ray. Common symptoms In addition to shortness of breath and chronic cough, sarcoidosis’s respiratory symptoms can include wheezing and chest pain. [sarcoidosisnews.com]

  A chest CT scan showed diffuse ground-glass opacities in the lungs, consistent with alveolitis, with small focal areas of consolidation. [studyblue.com]

• Heart Failure

  Pulmonary hypertension, H T A P (exercise dyspnea, holosystolic murmur of tricuspid insufficiency, B2 shine in the pulmonary focus, right heart failure) or haemoptysis are signs of severity. [youtube.com]

  […] varied significantly between medical appointments were more likely to have a heart attack, a stroke, or heart failure. [medicalnewstoday.com]

  These symptoms may include: Headache Dizziness Weakness As with chronic cases of high blood pressure, years of poor management may lead to stroke, heart disease, and heart failure. [belmarrahealth.com]

  Heart disease This can (rarely) cause sudden death from arrhythmias or cause symptoms of heart failure in a young patient, due to cardiomyopathy [ 8 ]. [patient.info]

  heart failure, pericarditis or papillary muscle dysfunction (valvular heart disease). [dermnetnz.org]

• Heart Block

  block Histopathology reveals aggregates of epithelioid cells with pale-staining nuclei, which form the characteristic discrete non-caseating granulomas. [pcds.org.uk]

  block. [38] Second to conduction abnormalities, in frequency, are ventricular arrhythmias, which occurs in about 23% of persons with cardiac involvement. [38] Sudden cardiac death, either due to ventricular arrhythmias or complete heart block is a rare [en.wikipedia.org]

• Visual Impairment

  They may develop hypercalcemia, and the presence of persistent hypercalcemia and subsequent hypercalciuria can damage the kidneys and lead to renal impairment. [derm101.com]

• Prolapse

  Other labi descendants in English include collapse, elapse,prolapse, and simply lapse. [merriam-webster.com]

• Arthritis

  We report two cases of cutaneous granuloma induced by anti-TNF-alpha therapy: a 47-year-old man suffering from psoriatic arthritis treated with infliximab and a 56-year-old woman treated with adalimumab for polyarticular juvenile rheumatoid arthritis. [ncbi.nlm.nih.gov]

  Etanercept has been approved for the treatment of psoriasis, psoriatic arthritis, rheumatoid arthritis, and juvenile rheumatoid arthritis. Treatment with infliximab and etanercept was generally well tolerated and safe in these reports. [clinicaltrials.gov]

  The different forms of chronic arthritis that may occur among patients with sarcoidosis are: non-deforming arthritis with granulomatous synovitis; Jaccoud-type deformity (non-erosive); articular edema adjacent to the osseous lesion by sarcoidosis; dactylitis [scielo.br]

  […] tissues) or arthralgia (painful joints) may occur Arthritis is most commonly acute (coming on suddenly), resulting in swelling of the lower legs and tenderness of ankles, knees and fingers Chronic (long term) sarcoid arthritis is rare Calcium metabolism [dermnetnz.org]

• Arthralgia

  Other symptoms include anterior uveitis, fever, ankle periarthritis, arthralgias, and pulmonary involvement. [emedicine.medscape.com]

  There was no history of fever, chill, arthralgia, weight loss, cough or visual disturbances. There was no history of insect bite, trauma or any other systemic complaints. Past and family history was not contributory. [e-ijd.org]

  Granulomas can appear in the brain, spinal cord, and facial and optic nerves May result in headache, confusion and malaise Facial paralysis Musculoskeletal Arthritis (inflammation of the joints), periarthritis (inflammation of surrounding tissues) or arthralgia [dermnetnz.org]

• Myopathy

  […] or cause renal failure secondary to hypercalcaemia, hypercalciuria and nephrocalcinosis Other organ involvement Includes the nervous system (optic nerve involvement, cranial nerve palsy, peripheral neuropathy), deranged LFT, diabetes insipidus, and myopathy [pcds.org.uk]

  Hypercalcaemia 9. myocardial disease 10. myopathy or myositis 11. Thrombocytopenia 12. other significant organ involvement—for example, kidneys Sarcoidosis. Johns CJ, Scott PP, Schonfled SA. Ann Rev Med 1989; 40: 353–71. 90. [slideshare.net]

  Joints It tends to present as an inflammatory arthritis (often oligoarticular initially) with periarticular soft-tissue swelling, tenosynovitis, dactylitis, osteopenia and associated myopathy. [patient.info]

  "Mycophenolate mofetil may be effective in CNS sarcoidosis but not in sarcoid myopathy". Neurology. 76 (13): 1168–72. doi : 10.1212/WNL.0b013e318212aafb. PMID 21444902. ^ Judson MA (October 2012). "The treatment of pulmonary sarcoidosis". [en.wikipedia.org]

• Joint Swelling

  Physical exam was significant for bilateral wrist, knee and ankle joint swelling with point tenderness, right lower lobe rales and a left shoulder black tattoo with firm subcutaneous papules and nodules overlying the pigment. [shmabstracts.com]

• Erythema

  KEYWORDS: Cutaneous sarcoidosis; Erythema nodosum; Granulomas; Lupus pernio; Löfgren syndrome; Noncaseating [ncbi.nlm.nih.gov]

  Skin Lesions in Sarcoidosis Erythema nodosum Lupus pernio Papules, nodules, and plaques psoriatic like lesions lesions in scars and tattoos The acute triad of erythema nodosum, joint pains, and bilateral hilar adenopathy, LOFGREN'S SYNDROME, is highly [meddean.luc.edu]

  Various skin lesions - papules, pustules, plaques, macules, etc., including erythema nodosum and lupus pernio, may constitute the clinical presentation of cutaneous sarcoidosis. [symptoma.com]

  They are known as erythema nodosum, lupus pernio, and plaque-like lesions. Erythema nodosum is characterized by the sudden appearance of tender bumps, about 1 to 2 cm in diameter, mostly on the shins. [sarcoidosisnews.com]

  The presence of erythema nodosum indicates a good prognosis.[2] Most authors divide the lesions of cutaneous sarcoidosis into nonspecific and specific types. [indianjrheumatol.com]

• Papule

  The most common types of specific lesions are papules. They commonly occur on the face, but may also occur anywhere on the body. While only a few papules may be noted, multiple scattered or confluent lesions are more common. [indianjrheumatol.com]

  Cutaneous examination revealed multiple, discrete, erythematous papules [Figure 1] along with flat-topped, violaceous papules and plaques, morphologically classical of lichen planus [Figure 2] lesions over the face, forearm, abdomen and leg. [ncbi.nlm.nih.gov]

• Skin Disease

  There was no significant difference in cutaneous presentation between those who had isolated skin disease and those who had skin disease in association with systemic sarcoidosis. [ncbi.nlm.nih.gov]

• Skin Plaque

  Skin plaques and lupus pernio are associated with chronic sarcoidosis. [ncbi.nlm.nih.gov]

  […] show granulomas on histology (microscopic examination of a skin biopsy) and include: lupus pernio: large bluish-red and dusky purple infiltrated nodules and plaque-like lesions on nose, cheeks, ears, fingers and toes (not chilblains) skin plaques: purple-red [dermnetnz.org]

  Laser surgery has been used in treating disfiguring skin plaques and lupus pernio. [sarcoidosisnews.com]

• Hyperpigmentation

  Portez une attention particulière et régulière à: les tatouages; vieilles cicatrices; taches blanches ou même foncées sur la peau (hypo- et hyperpigmentation). [sarcoidosisuk.org]

  Photodynamic therapy has a considerable effect; however, various side-effects, such as hyperpigmentation, desquamation, headache, burning and prickling sensation, erythema, and oedema were described (9, 3). [medicaljournals.se]

  Slight hyperpigmentation of the treated area occurred after 2 weeks of treatment and persisted for about 3 months after the end of PDT (Figure 3). [jamanetwork.com]

  A 1.5-cm x 1.5-cm shallow ulcer with surrounding hyperpigmentation was present lower on the leg. Ms. J had minimal lower extremity edema and normal distal pulses. [o-wm.com]

  Ulcerative Sarcoidosis Venous ulcer Edema - + Hyperpigmentation in surrounding skin - + Granuloma + - 43. Ulcerative sarcoidosis. Case report and review of the literature Albertini JG, Tyler W, Miller OF. [slideshare.net]

• Kidney Failure

  Kidney damage to sarcoidosis is rare but can progress to kidney failure. The two most common mechanisms are tubulointerstitial nephropathy and acute hypercalcemic renal failure. [youtube.com]

  Other potential complications may include: lung infection cataracts, which is characterized by a clouding of the lens of your eye glaucoma, which is a group of eye diseases that can cause blindness kidney failure abnormal heart beat facial paralysis infertility [healthline.com]

  Kidneys. Sarcoidosis can affect how your body handles calcium, which can lead to kidney stones and reduce kidney function. Rarely, this can lead to kidney failure. Heart. [mayoclinic.org]

  The effects may include bleeding in the eyes, kidney failure, heart rhythm irregularities, heart attack, aneurysm rupture, or stroke. [verywellhealth.com]

• Amenorrhea

  […] temperature, mood, and prolactin (see the endocrine and exocrine section for details). [47] Endocrine and exocrine [ edit ] Prolactin is frequently increased in sarcoidosis, between 3 and 32% of cases have hyperprolactinemia [52] this frequently leads to amenorrhea [en.wikipedia.org]

• Peripheral Neuropathy

  Sarcoidosis may either involve the kidneys directly or cause renal failure secondary to hypercalcaemia, hypercalciuria and nephrocalcinosis Other organ involvement Includes the nervous system (optic nerve involvement, cranial nerve palsy, peripheral neuropathy [pcds.org.uk]

  Nerves/central nervous system (CNS) Check the function of the VIIth and other cranial nerves and peripheral sensory/motor nerve function to detect peripheral neuropathy. Formal neurological examination is appropriate if there are relevant symptoms. [patient.info]

  "Nerve granulomas and vasculitis in sarcoid peripheral neuropathy: a clinicopathological study of 11 patients". Brain. 125 (Pt 2): 264–75. doi : 10.1093/brain/awf027. PMID 11844727. ^ Tavee J, Culver D (June 2011). [en.wikipedia.org]

  Neurosarcoidosis is uncommon, affecting fewer than 10% of patients, and may manifest as cranial nerve disease (particularly a facial nerve palsy), peripheral neuropathy, or neuromuscular disease. [dermatologyadvisor.com]

  Teratogenicity and peripheral neuropathy have, however, limited the use of thalidomide. Other dose-dependent adverse effects include somnolence, thrombosis, constipation, dizziness and rash. [em-consulte.com]

• Lethargy

  General Lethargy, arthralgia and weight loss Respiratory Cough and/or chest pain Shortness of breath associated with lung fibrosis Upper respiratory tract involvement produces hoarseness, nasal obstruction and recurrent or persistent sinusitis Ocular [pcds.org.uk]

  The onset of the disease is usually insidious but may be occasionally associated with lethargy, weight loss and general malaise.[7] Polyarthritis and moderate to high fever, however, are usual in patients presenting with erythema nodosum. [ijdvl.com]

• Asthenia

  General signs: Fatigue, asthenia can be deep, in the foreground, or even isolated. [youtube.com]

As cutaneous sarcoidosis possesses numerous types of lesions, it might be difficult to establish a diagnosis solely on clinical criteria. Nevertheless, the initial suspicion towards this inflammatory disease can only be raised after a thorough physical examination and a meticulously obtained patient history [4] [6]. This condition often (but not always) precedes involvement of other organs and systemic symptoms, thus the detection of associated lesions is perhaps the only tool in making a presumptive diagnosis. Given the systemic nature of the disease, a thorough laboratory workup should be performed, comprising liver and kidney function tests, serum inflammatory markers, and angiotensin-converting enzyme (ACE) [1] [6]. In addition, chest radiography, pulmonary function tests, electrocardiography (ECG), and a complete ophthalmologic exam are recommended in the workup [6]. To confirm the diagnosis of cutaneous sarcoidosis, however, biopsy of the skin with subsequent histopathological examination is the gold standard [1]. A punch biopsy allows a satisfying amount of tissue to be obtained, and the presence of non-caseating granulomas is virtually a pathognomonic finding of sarcoidosis [1] [5].

• Candida

  People with sarcoidosis often have immunologic anomalies like allergies to test antigens such as Candida or purified protein derivative. [57] Polyclonal hypergammaglobulinemia is also a fairly common immunologic anomaly seen in sarcoidosis. [57] Lymphadenopathy [en.wikipedia.org]

Treatment modalities included steroid, hydroxychloroquine, cyclosporine, topical tacrolimus, and pulsed dye laser. [ncbi.nlm.nih.gov]

Erythema nodosum is the most common nonspecific skin manifestation, and it portends a good prognosis. Specific skin lesions have a varied clinical appearance, although often they can be distinguished by their yellow translucent character. [ncbi.nlm.nih.gov]

The prognosis and natural history of sarcoidosis is unclear, because of the rarity of the disease and small number of cases reported. However, the overall prognosis is good as it is usually self-limiting, non-life-threatening disease. [jnsbm.org]

The identified TLR expression in cutaneous sarcoidosis indicates that a bacterial antigen could be an etiologic agent of the disease. [ncbi.nlm.nih.gov]

BACKGROUND: The epidemiology of cutaneous sarcoidosis is not well-characterized as only referral-based studies are available. [ncbi.nlm.nih.gov]

Hywel Williams Professor of Dermato-Epidemiology, Nottingham UK. Professor Williams is coordinating editor of the Cochrane Skin Group. [books.google.com]

This review will highlight developments in the epidemiology, clinical presentation, diagnosis and treatment of cutaneous sarcoidosis over the past several years. [ingentaconnect.com]

Internal Medicine (643) Pathology and Forensic Medicine (492) Paediatrics, Neonatology (487) Physiology and Pathophysiology (406) Infectology (342) Medical Chemistry and Biochemistry (325) Microbiology (287) Cardiology, Angiology (253) Surgery, Traumatology [portal.mefanet.cz]

Pathophysiology of Baroreflex Failure In baroreflex failure, there is interrupted afferent baroreflex input, as well as efferent parasympathetic output. [ncbi.nlm.nih.gov]

While the pathophysiology is unclear, both prior research and our findings suggest that not only does sarcoidosis affect blacks more often than whites, blacks are also more likely to develop cutaneous disease. [austinpublishinggroup.com]

Further investigation may provide valuable insight into the immune-pathophysiology behind these diseases and ultimately aid in new therapeutic advances. [omicsonline.org]

The knowledge of the adaptive immunological mechanisms operative in cutaneous sarcoidosis may subsequently be useful for identifying prevention and treatment strategies of systemic sarcoidosis. [ncbi.nlm.nih.gov]

Prevent hand-foot-and-mouth disease It’s contagious, but you can reduce your child’s risk of catching it. Find out what helps. Scabies? Treat everyone! If your child develops scabies, everyone in your household will need treatment. [aad.org]

This helps relieve symptoms and prevent damage to affected organs by reducing inflammation and preventing scarring. However, steroid tablets can cause unpleasant side effects such as weight gain and mood swings if taken in high doses. [nhs.uk]

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2. Dybiec E, Pietrzak A, Bartosińska J, Kieszko R, Kanitakis J. Ultrasound findings in cutaneous sarcoidosis. Postepy Dermatol Alergol. 2015;32(1):51-55.
3. Haddad N, de Oliveira J, Nasser K da R, Corbett AMF, Tebet ACF, Reis MLJ. Musculoskeletal and cutaneous sarcoidosis: exuberant case report. An Bras Dermatol. 2014;89(4):660-662.
4. Tong C, Zhang X, Dong J, He Y. Comparison of cutaneous sarcoidosis with systemic sarcoidosis: a retrospective analysis. Int J Clin Exp Pathol. 2014;7(1):372-377.
5. Kumar HKS, Gayathri MN, Bharathi M, Ravikumar T. Isolated Cutaneous Sarcoidosis: A New Insight into the Old Entity. J Clin Diagn Res. 2013;7(8):1725-1726.
6. Katta R. Cutaneous sarcoidosis: a dermatologic masquerader. Am Fam Physician. 2002;65(8):1581-1584.