SARCOIDOSIS AND THE SKIN
Sarcoidosis of the skin occurs in 20 to 35% of all sarcoidosis patients. Sometimes a skin condition may be the only complaint. There are several types of skin disorders that can occur with sarcoidosis including erythema nodosum, lupus pernio and brownish-red lumps and bumps (lesions).
Erythema Nodosum is the most common sarcoidosis related skin condition. It often occurs in the acute form of the disease.
- sudden red, painful lumps, usually on lower legs or arms
- often accompanied by fever, fatigue and joint pain
- often improves spontaneously after 3 to 6 weeks, simple painkillers such as paracetamol and ibuprofen can help with the symptoms
- purple-blue colouring may remain visible for a few weeks
- within 6 months 80% cases heal completely without scarring
The majority of patients with erythema nodosum have conditions other than sarcoidosis (e.g. bacteria or fungal infections). In addition, certain medications can cause it. This skin condition does not always automatically indicate sarcoidosis.
Lupus Pernio can also occur in sarcoidosis.
- blue/red flat discoloration, or swelling, usually across the bridge of the nose and cheeks
- painful skin
- superficial lesions
- occurs on the face, ears, fingers or toes
Lupus pernio is a chronic condition; it rarely disappears spontaneously and can cause permanent damage to the skin where it occurs. Proper and timely medication for this skin condition is very important.
Referral to a dermatologist (specialist skin doctor) is required for patients with Lupus Pernio.
Other Skin Lesions
The skin may produce thick bumps (nodules) and smaller bumps of a few millimeters in diameter (papules). In some cases, these bulges sit so close together that they form a sort of plate, also called plaque. These lesions most commonly occur on the extremities, face, scalp, back, and buttocks. They are usually reddish-brown in colour and are not usually symptomatic. These lesions most commonly occur on the extremities: face, scalp, back, and buttocks.
- lumps in the skin
- colour varies from red/blue to yellow/red
- plaques feel hard and sometimes form a ring on the skin
Techniques to Understand your Condition
Patients with sarcoidosis of the skin should be evaluated for involvement of other organs, such as the lungs and the liver.
The progression of skin sarcoidosis varies, usually keeping pace with the diseases activity in the lung.
In most cases, a review of the skin by a dermatologist (specialist skin doctor) is sufficient.
Sometimes it is necessary to take a biopsy of the skin. Your doctor will take a test piece of skin to be examined under a microscope.
Inspect your Skin!
Sarcoidosis can cause changes to the skin. Pay particular and regular attention to:
- old scars;
- white or even dark-colored spots on the skin (hypo- and hyperpigmentation).
If you notice any changes in your skin, it is wise to have these checked by your doctor.
Skin disorders during sarcoidosis are often spontaneous and pose no threat to general health. Therefore, full recovery is seen in many cases. However sometimes the skin is so damaged, painful or disfiguring that the patient may feel very physically or socially uncomfortable. Skin lesions take time to recover. In these cases, the dermatologist may prescribe the following medications:
Ointments or creams contain corticosteroids which suppress the inflammation of the skin. However, corticosteroids can make the skin thin and fragile in the long term.
Corticosteroid tablets (e.g. prednisolone) may be prescribed for severely disfiguring disorders and conditions that do not heal spontaneously. The treatment with these drugs usually takes a number of months. Prescriptions will only be given in the most serious of cases due to adverse side effects of corticosteroids.
Hydroxychloroquine/Mepacrine These medicines were originally used in the treatment of malaria. Dermatologists may prescribe these drugs to treat various forms of skin sarcoidosis.
Immunosuppressant drugs inhibit cell division and are only prescribed if corticosteroids do not provide sufficient recovery. Methotrexate is an example of such a medication. Although your GP may be able to provide ongoing prescriptions, these medications should be supervised by a consultant dermatologist.
Sarcoidosis and Tattoos
There is a reported risk that sarcoidosis can be triggered, or existing symptoms worsened, by tattoos. A flare up is indicated by nodules appearing on the tattoo. Some patients have actually been diagnosed with sarcoidosis due to their tattoos suddenly producing raised scars. Some colours are more likely to cause problems than others.
The interaction between sarcoidosis symptoms and tattoos may be caused by either the tattoo procedure breaking the skin or the tattoo ink itself. Not all patients are affected – some may not experience any symptoms, particularly if they do not have skin sarcoidosis.
SarcoidosisUK therefore recommends that patients with sarcoidosis do not get tattoos, particularly those patients with existing skin sarcoidosis. If you are concerned about existing tattoos or would like to discuss your options, contact the SarcoidosisUK Nurse Helpline or your GP.
Read more: Tattoo Sarcoidosis (Lyons, A., Brayman, G. & Tahhan, S. J GEN INTERN MED (2018) 33: 128.)
Page last updated: July 2019. Next review: July 2021.
Related content from SarcoidosisUK:
Sarcoidosis and Fatigue
Do you experience fatigue? Find symptoms, treatment and more information about sarcoidosis and fatigue.
Do you want to find a consultant? Use our directory to find a sarcoidosis specialist or clinic near you.
Sarcoidosis and the Lung
Do you have pulmonary sarcoidosis? Does sarcoidosis affect your lungs. Click here to learn more.