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27 November 2017, by TOONSTRA J.


Sarcoidosis is a systemic disease characterized by the development of non-caseating granulomas in multiple organs. The pathophysiology is still unknown. The current concept is that the pathogenesis of sarcoidosis involves a T-helper-1-mediated immune response to environmental antigens in a genetically susceptible host [1]. Sarcoidosis is found more frequently and at an earlier age and more severe in Blacks as compared to Caucasians whereas the prognosis is often worse in Blacks. Increased rates of pulmonary involvement and more frequent relapses are more common in skin of color [2, 3]. In infants sarcoidosis is rare.
Sarcoidosis can affect virtually any organ system in the human body. The skin is second to the lungs the most commonly affected organ [4]. In about 20-35% of cases skin involvement is present. Skin involvement may be isolated as the only sign of sarcoidosis but it can also be part of a more or less severe systemic picture.

Skin involvement can be divided in non-specific lesions of which erythema nodosum is the most important and characteristic example, occurring in up to 25% of cases, and in specific skin lesions in which the sarcoid non-caseating granulomas can be found on histopathology.
Cutaneous manifestations of sarcoidosis are extremely variable. Therefore it is considered one of the great imitators in dermatology, comparable with syphilis. The skin lesions can present commonly as macules or papules, and less frequently as annular lesions and nodules [3, 5]. One must be aware of less common forms of cutaneous sarcoidosis.

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