Sarcoidosis of the Skin

Sarcoidosis is a condition of unknown cause that can affect many organs.

The lungs, skin, eyes, and lymph nodes are most commonly involved. The heart, brain, and other organs are less commonly involved. Sarcoidosis causes granulomas, which are collections of immune cells that can lead to damage of the involved tissue. When that inflammation affects the skin, it is called cutaneous sarcoidosis or sarcoidosis of the skin.

Sarcoidosis of the skin can look many ways. The most common lesions are small bumps and broad, raised skin lesions. They are often red-brown or purple, but can also be flesh colored or shades of tan or brown. They can be smooth or rough. These lesions can occur anywhere on the skin, although the face is frequently involved. Skin sarcoidosis typically does not cause itching or burning. However, it can lead to long-lasting discoloration or scarring.

Sarcoidosis of the skin has different patterns in the way it appears. For example, sarcoidosis may appear as bumps within existing tattoos (tattoo-associated sarcoidosis) or scars. The lupus pernio variant has lesions around the nose. Lupus pernio may need more aggressive treatment. It can lead to scarring and tends to occur with sinus, throat, and lung damage. Lupus pernio is often resistant to standard treatments. Rarely, sarcoidosis can show up as thicker scaly spots (verrucous sarcoid), lighter spots (hypopigmented sarcoid), lumps underneath the surface (subcutaneous sarcoid), or broad areas of dry scaly skin on the legs (ichthyosis).

When concerned about possible skin sarcoidosis in a patient, physicians often perform a skin biopsy. They will also ask about any symptoms that could suggest involvement of other organs, like vision changes, eye pain, cough, difficulty breathing, or abnormal heart rhythms. The medical team may order blood tests, heart tests, imaging studies, and an eye examination.

Sarcoidosis of the skin typically requires treatment to heal. The treatment plan will depend on how many skin lesions of sarcoidosis there are, how quickly new lesions appear, and the location of the lesions, among other characteristics. Treatment for mild sarcoidosis may include creams, ointments, or injections into the skin lesions. For severe sarcoidosis with many lesions or lesions on the face, treatment may also include medications taken orally or injectable or intravenous medications in some cases. Usually, patients with sarcoidosis are cared for by a team of physicians. Treatment may be coordinated with other specialists who treat sarcoidosis in other organs to find the best therapy.

Published Online: October 12, 2022. doi:10.1001/jamadermatol.2022.0360

Conflict of Interest Disclosures: Dr Rosenbach reported consulting for AbbVie, Janssen, Eli Lilly, Merck, Novartis, Xentria, and Processa, receiving research support from Processa, and advisory board service for the Foundation for Sarcoidosis Research.