[Solved by Experts] Comprehensive Multisystem Evaluation Including
Sarcoidosis is a systemic disease mostly characterized by its pulmonary involvement. Sarcoisosis is an inflammatory condition that is associated with the presence of granulomas found inside and surrounding involved organs (Khawar, Chatta & Sandhu, 2021). Over 90% of patients with sarcoidosis have airway, lung, and parynchmeal tissue involvement (Khawar et al., 2021). Sarcoidosis is a diagnosis of exclusion and requires a comprehensive multisystem evaluation including tissue biopsy and careful consideration of other etiologies capable of presenting with similar clinical findings (Khawar et al., 2021). The AGACNP must inquire about and examine the eyes, cardiac, renal hepatic and central nervous systems, as these are also known to be susceptible to sarcoidosis involvement. The diagnosis of sarcoidosis requires fulfillment of three criteria including compatible presentation, histopathological confirmation of noncaseating granulomas and exclusion of other conditions which may present similarly (Khawar et al., 2021).
It is important to note that a considerable amount of patients present with skin manifestations of saroidosis. Plaques are commonly seen in patients with cutaneous sarcoidosis, which can be described as elevated lesions that are mostly found on the face, neck, or extremities, and less often on the trunk (Khawar et al., 2021). These lesions are round-to-oval shaped and red-brown to purple in color (Khawar et al., 2021). Differential diagnoses for such plaque presentations include Kaposi’s Sarcoma, tertiary syphillis, and lichen planus. Symptoms of cutaneous sarcoidosis include itching, redness, swelling, and warmth at the site of inflammation (Jadotte, Hay, Salphale, Mocelin, Kumar, Niazi & Pilati, 2018). Although skin granulomas can spontaneously heal, like other forms of inflammation when prolonged, they may eventually lead to scarring at their location, resulting in irreparable damage and permanent disfigurement (Jadotte et al., 2021). If found on examination, depending upon history, referral to immunology, pulmonology, or plastic surgery may be warranted.
First line treatment for localized involvement of cutaneous sarcoidosis, which is typically less than 5% of the total body surface area, usually involves intralesional (injected) or topical corticosteroids (Khawar et al., 2021). Facial and genital lesions usually are managed with medium (rather than high-potency) topical corticosteroids, because of an increased risk of treatment-induced skin atrophy (Khawar et al., 2021). Systemic glucocorticoids are commonly reserved as second-line treatment for skin manifestations which are rapidly spreading, may result in permanent disfigurement, or are nonresponsive to topical and intralesional steroids (Khawar et al., 2021). Extensive disease and patients with corticosteroid dependence require antimalarial agents (hydroxychloroquine or chloroquine) and methotrexate (Khawar et al., 2021).
Khawar, Chatta & Sandhu, 2021. Cutaneous manifestations of sarcoidosis. Journal of the Dermatology Nurses’ Association, 13(4), 219-223. DOI:10.1097/JDN.0000000000000626.
Jadotte, Y. T., Abdel Hay, R., Salphale, P., Mocellin, S., Kumar, S., Niazi, A., & Pilati, P. (2018). Interventions for cutaneous sarcoidosis. The Cochrane Database of Systematic Reviews, 2018(8), CD010817. https://doi.org/10.1002/14651858.CD010817.pub2.