A CASE REPORT OF SARCOIDOSIS CUTIS LICHENOIDES

Abstract

Background: Sarcoidosis is a chronic multisystem granulomatous disease of unknown etiology, characterised bytheformation of noncaseating granulomas in the involved organs, such as the skin, lung, lymph nodes, eyes, joints, brain, kidneys and heart. Cutaneous involvement is about 25% with different clinical presentations, including papules, nodules, plaques, and infiltrated scars. The lichenoid pattern is one of the rarest types of cutaneous sarcoidosis. Purpose: To present 50 –year-old woman diagnosed with Sarcoidosis cutis lichenoides. Material and methods: We present a 50-year-old woman in good general condition, with skin rashes localised on upper limbs. The disease started four months ago. From physical examination, pathological cutaneous lesions affected right and left forearms and cubital folds, presented by papules of various sizes, pink in colour, smooth and shiny. Complete blood count, biochemistry, urine analysis and microbiology were in normal ranges except elevated levels of alpha-1 globulin and gamma- globulin. X-rays examination and abdominal ultrasound were normal too. Mantoux test was negative. Histopathological examination demonstrated granulomas located in the papillary dermis and composedof epithelioid and giant cells, a few lymphocytes, without necrosis. Consultations with pulmonologist and ophthalmologist showed no abnormalities. Results: The diagnosis Sarcoidosis cutis lichenoides was based on the medical history, general status, and morphological characteristics of skin lesions, histopathological examination and consultations. In the absence of organ involvement, systemic therapy with Methylprednisolone and topical treatment with Flumetasone pivalate 0.2mg/Salicylic acid 30mg/g was started. On the 5th day of treatment, we revealed initial resorption of papules. After discharging the patient from the hospital, systemic therapy with Methylprednisolone and topical treatment with Tacrolimus 0.1% ointment was conducted. There were no new lesions 3 months after the end of the therapy with Tacrolimus 0.1% ointment.

Keywords

• Sarcoidosis cutis lichenoides
• lichenoid pattern
• tacrolimus