Sarcoidosis
April is National Sarcoidosis awareness month. Sarcoidosis is not a well-known disorder, but it can be quite devastating to those affected. It primarily affects the lungs but can also affect the skin. Before talking about how sarcoidosis appears on the skin, I’ll tell a little story if you’ll humor me?
When I was in residency, we went to the National Institute of Health every month for a conference. While there, we would examine “mystery” patients. After talking to and examining those patients, we had to come up with a list of possible diagnoses. It was often a joke that we could always put sarcoidosis on the skin because sarcoidosis can “look like anything and everything.” During the conference, the well-seasoned and powerful team at the NIH would call on one of us poor residents. We would have to stand up and give our list of possible diagnoses for the mystery patients. Inevitably, if we did not include sarcoidosis on our list, someone would pipe up and add it for us. It was a nerve-wracking and educational experience that I won’t forget. So, sarcoidosis is often in the back of my mind when I see patients. But in reality, I have only a few patients that I have seen particularly for sarcoidosis of the skin.
What is sarcoidosis? Sarcoidosis is a multisystem disorder that can affect almost any organ system but most commonly affects the lungs, liver, and skin. About 1/3 of people with sarcoidosis have skin involvement. It is an inflammatory disorder with no known cause or cure. Diagnosis is made by seeing granulomas, a type of inflammatory pattern, on a biopsy. Granulomas can also be seen in other things like infection as well, so when all other causes of granulomas are ruled out, it is called sarcoidosis.
What does sarcoidosis look like? Sarcoidosis is called the “great imitator” because, as I said above, it can look like almost anything. It can mimic many other common skin disorders. When a rash is not responding as we think it should, sometimes we do a biopsy to make sure we have the diagnosis right. Finding sarcoidosis unexpectedly in a biopsy is pretty rare, so DON’T WORRY. Dermatologists are trained to identify skin disorders by looking and feeling, and not everything requires biopsy confirmation.
How is sarcoidosis treated? Treatment varies on the number of organs involved and the extent of the involvement on the skin. It can be successfully treated and go into remission, but often is a lifelong disorder. I have one patient who I have been treating for sarcoidosis of the skin for over ten years, who has been pretty clear for many years now. This patient is my only one with sarcoidosis in the skin only. Other patients I treat with sarcoidosis have other organs involved, so they are usually treated by the lung doctor. Generally, the goal of treatment is to suppress and get rid of the inflammatory response. For the skin, we can use topical steroids, but it often requires oral medications as well.
To learn more about sarcoidosis and supporting patients with sarcoidosis, visit www.stopsarcoidosis.org.
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