35: Sarcoidosis Flashcards
What is sarcoidosis and how is it characterized?
Sarcoidosis is a multisystem disease characterized by granulomatous inflammation of unknown etiology, commonly affecting the lungs and skin, but it can involve any organ system.
What are the common clinical features of sarcoidosis?
Common clinical features of sarcoidosis include:
- Lupus pernio: Symmetric, violaceous, indurated plaques and nodules on the nose, earlobes, cheeks, and digits.
- Mikulicz syndrome: Sarcoidal granulomas on mucosal surfaces, particularly in the lacrimal, parotid, sublingual, and submandibular glands.
- Darier-Roussy sarcoid: Persistent subcutaneous nodules that may be tender or painless, often occurring on extremities.
- Lofgren syndrome: Erythema nodosum with bilateral hilar adenopathy, arthralgia, and fever.
- Heerfordt syndrome: Fever, parotid gland enlargement, facial palsy, and anterior uveitis.
What are the epidemiological characteristics of sarcoidosis?
Epidemiological characteristics of sarcoidosis include:
- Occurs worldwide and affects all ages and races.
- Most common onset in the third decade of life, slightly higher in women.
- Higher incidence with greater distance from the equator.
- Highest prevalence found in whites in Denmark and Sweden, and in persons of African descent in the United States.
What types of cutaneous findings are associated with sarcoidosis?
Cutaneous findings in sarcoidosis include:
- Various morphologies such as macules, papules, patches, plaques, and nodules.
- Alopecia with scalp involvement and nail changes.
- Epidermal changes like scaling, telangiectasia, and atrophy.
- Lesions can occur before, coincident with, or after systemic involvement.
- Lesions are classified into specific (granulomatous inflammation) and nonspecific (reactive without sarcoidal granulomas).
What is the most common presentation of specific cutaneous lesions in sarcoidosis?
The most common presentation of specific cutaneous lesions in sarcoidosis is papules and plaques, with the papular form being the typical manifestation.
What are the two categories of cutaneous lesions in sarcoidosis?
Cutaneous lesions in sarcoidosis are divided into specific lesions, which have granulomatous inflammation histologically similar to other organs, and nonspecific lesions, which are reactive and do not exhibit sarcoidal granulomas.
What is the significance of the ‘apple jelly’ appearance in granulomatous lesions?
The ‘apple jelly’ appearance in granulomatous lesions is significant as it is reminiscent of the color change observed in these lesions. It is assessed by pressing a glass slide against the skin (diascopy), which accentuates the yellow-brown coloration. This appearance is not pathognomonic for sarcoidosis, as similar properties can be seen in other conditions like lupus vulgaris and granuloma annulare.
What dermoscopic findings are associated with cutaneous sarcoidosis?
Dermoscopic findings associated with cutaneous sarcoidosis include:
- Pink homogenous background
- Translucent orange areas
- Fine white scaling
- Scar-like depigmentation
These findings are significantly associated with cutaneous sarcoidosis when compared to necrobiosis lipoidica, granuloma annulare, and rheumatoid nodules.
What are the common characteristics of papular lesions in cutaneous sarcoidosis?
Common characteristics of papular lesions in cutaneous sarcoidosis include:
- Waxy appearance reflecting mild epidermal atrophy
- Location: Most commonly on the face and neck, particularly periorbital skin
- Symptoms: Typically asymptomatic without pain or pruritus
- Main complaint: Cosmetic disfigurement
- Color: May retain translucent yellow-brown coloration.
What is lupus pernio and what are its clinical features?
Lupus pernio is characterized by:
- Relatively symmetric, violaceous, indurated plaques and nodules
- Common locations: Nose, earlobes, cheeks, and digits
- Misnomer: The term ‘lupus pernio’ is preserved from the mistaken belief that these lesions are related to lupus vulgaris and cold injury.
- Potential complications: Lesions may directly extend into the nasal sinus, leading to epistaxis, nasal crusting, and possible bone involvement.
What is the most common presentation of specific cutaneous lesions in sarcoidosis?
The most common presentation of specific cutaneous lesions in sarcoidosis is the papular form, which often appears as firm, translucent red-brown or yellow-brown papules.
What diagnostic technique can be used to accentuate the yellow-brown coloration of sarcoidosis lesions?
Diascopy, which involves pressing a glass slide to the skin, can accentuate the yellow-brown coloration of sarcoidosis lesions, giving them an ‘apple jelly’ appearance.
What are angiolupoid lesions and where do they typically occur?
Angiolupoid lesions are pink and violaceous papules and plaques with prominent telangiectasias that usually occur on the face. They are often considered a variant of lupus pernio.
What is Scar Sarcoid and where does it typically occur?
Scar Sarcoid is a form of cutaneous sarcoidosis that occurs preferentially within scar tissue, at traumatized skin sites, and around embedded foreign material such as silica and tattoo ink.
What are the clinical features of mucous membrane involvement in sarcoidosis?
Sarcoidal granulomas may cause papules and plaques on the mucosal surface and tongue, leading to conditions such as ‘straw-berry gums’ which mimic Wegner granulomatosis.
What is erythema nodosum and its significance in sarcoidosis?
Erythema nodosum is the main nonspecific cutaneous manifestation of sarcoidosis, often presenting with bilateral hilar adenopathy, arthralgia, and fever, and is frequently the initial manifestation of sarcoidosis (Lofgren syndrome).
What are the pulmonary implications of sarcoidosis?
The lung is the most common organ involved with sarcoidosis, with findings on pulmonary examination usually absent. Patients may experience dyspnea, cough, chest pain, hypoxemia, and wheezing. Sarcoid lesions can lead to pulmonary fibrosis, pulmonary hypertension, and chronic Aspergillus infection.
What is the condition called when a patient presents with violaceous, indurated plaques on the nose and cheeks?
This condition is called lupus pernio. It is associated with upper respiratory tract involvement, pulmonary fibrosis, and bony cysts.
What is the term for the manifestation that occurs preferentially within scar tissue in sarcoidosis?
This manifestation is called scar sarcoid, which occurs preferentially within scar tissue and may be the only finding in a patient with significant systemic involvement.
What is the term for the strawberry-like gingival lesions in sarcoidosis?
This manifestation is called ‘strawberry gums’ and can mimic Wegener granulomatosis.
What are the potential complications of granulomatous inflammation in the lungs?
Granulomatous inflammation in the lungs can lead to pulmonary fibrosis, pulmonary hypertension, and chronic Aspergillus infection.
What is the most common symptom of pulmonary sarcoidosis?
The most common symptom of pulmonary sarcoidosis is dyspnea, although patients are often asymptomatic.
What is the term for lesions that occur preferentially within scar tissue in sarcoidosis?
Lesions that occur preferentially within scar tissue are called scar sarcoid.
What is the term for the relatively symmetric, violaceous, indurated plaques and nodules occurring on the nose and cheeks?
These lesions are called lupus pernio.
What is the term for the pink and violaceous papules and plaques with prominent telangiectasias that occur on the face?
These lesions are called angiolupoid lesions.
What is the term for the bilateral enlargement of the lacrimal, parotid, sublingual, and submandibular glands?
This condition is called Mikulicz syndrome.
What is the nonspecific cutaneous manifestation that includes erythema nodosum?
The nonspecific cutaneous manifestation that includes erythema nodosum is a hallmark of Lofgren syndrome.
What are the potential complications of pulmonary fibrosis in sarcoidosis?
Pulmonary fibrosis in sarcoidosis can lead to pulmonary hypertension and chronic Aspergillus infection.
What syndrome is suggested by bilateral hilar adenopathy and erythema nodosum?
This presentation suggests Lofgren syndrome, which is an acute form of sarcoidosis with a good prognosis and eventual resolution.
What are the common ocular manifestations of sarcoidosis?
Common ocular manifestations of sarcoidosis include:
- Uveitis: Most common, can lead to glaucoma and cataracts.
- Conjunctivitis: Inflammation of the conjunctiva.
- Keratoconjunctivitis sicca: Dry eyes due to lacrimal gland involvement.
- Optic neuritis: Can rapidly lead to vision loss.
- Heerfordt syndrome: Includes fever, parotid gland enlargement, facial palsy, and anterior uveitis.
What are the clinical implications of cardiac involvement in sarcoidosis?
Cardiac involvement in sarcoidosis is found in about 5% of patients, with myocardial granulomas present in approximately 25% at autopsy. Clinical implications include:
- Cardiac arrhythmias: Most common clinical problem.
- Left ventricular dysfunction: Can lead to congestive heart failure.
- Electrocardiogram: Recommended for every patient diagnosed with sarcoidosis to monitor cardiac health.
What are the neurological manifestations associated with neurosarcoidosis?
Neurosarcoidosis can affect any part of the central or peripheral nervous system, with the following manifestations:
- Cranial neuropathies: Most common, particularly affecting the facial nerve.
- Mass lesions: May develop in the brain or spinal cord.
- Aseptic meningitis: Inflammation of the protective membranes covering the brain and spinal cord.
- Peripheral neuropathy: Nerve damage leading to weakness or pain.
How does renal sarcoidosis affect kidney function?
Renal sarcoidosis can affect kidney function through:
- Granulomatous inflammation: Directly affecting kidney tissue.
- Nephrolithiasis: Resulting from hypercalcemia due to increased 1α-hydroxylase activity in activated macrophages, leading to elevated levels of 1,25-dihydroxyvitamin D.
What is the significance of hepatic involvement in sarcoidosis?
Hepatic involvement in sarcoidosis is common but often asymptomatic. Key points include:
- Histologic evidence: Sarcoidal granulomas are frequently found in the liver.
- Biopsy: Can confirm diagnosis if needed.
- Serum alkaline phosphatase: Increased in about 33% of patients, but does not require treatment unless symptomatic.
What triggers the immune response in sarcoidosis?
Sarcoidosis is triggered by exposure to antigens that lead to hyperactivity of the cell-mediated immune system, resulting in granulomatous inflammation. Key processes include:
- Antigen-presenting cells: Such as macrophages, process and present antigens to CD4+ T cells.
- Th1 subtype activation: The processed antigen is presented via HLA class II molecules.
- Cytokine production: Activated macrophages produce IL-12, promoting a Th1 response and secretion of IFN-γ by T lymphocytes.
What is the underlying mechanism for hypercalcemia in sarcoidosis?
Hypercalcemia in sarcoidosis is caused by activated sarcoidal macrophages, which have increased 1α-hydroxylase activity, converting 25-hydroxyvitamin D to its active form, 1,25-dihydroxyvitamin D.
What is the term for sarcoidosis involving the nervous system, and what is its most common manifestation?
Sarcoidosis involving the nervous system is called neurosarcoidosis, and its most common manifestation is cranial neuropathies, particularly involving the facial nerve.
What is the clinical significance of granulomatous inflammation in the liver?
Liver involvement in sarcoidosis is common but rarely causes clinically relevant signs or symptoms. Histologic evidence of granulomas is often used for diagnosis.
What is the underlying cause of cardiac arrhythmias in sarcoidosis?
Cardiac arrhythmias in sarcoidosis are caused by myocardial granulomas. An electrocardiogram is recommended for every patient diagnosed with sarcoidosis.
What is the potential outcome of untreated optic neuritis in sarcoidosis?
Optic neuritis in sarcoidosis may rapidly lead to vision loss if not treated promptly.
What are the potential complications of granulomatous inflammation in the kidneys?
Granulomatous inflammation in the kidneys can lead to nephrolithiasis, hypercalcemia, and hypercalciuria.
What are the potential hematologic complications of granulomatous inflammation in the spleen?
Granulomatous inflammation in the spleen may lead to reduction in any blood cell line, splenic sequestration, and bone marrow involvement, causing leukopenia.
What is the term for granulomatous inflammation in the brain, and what are its potential manifestations?
This condition is called neurosarcoidosis. Potential manifestations include cranial neuropathies, mass lesions in the brain or spinal cord, aseptic meningitis, and peripheral neuropathy.
What laboratory finding is commonly associated with granulomatous inflammation in the liver?
An increase in serum alkaline phosphatase occurs in approximately 33% of patients with liver involvement in sarcoidosis.
What is the term for granulomatous inflammation in the brain associated with sarcoidosis, and what are its potential manifestations?
This condition is called neurosarcoidosis. Potential manifestations include cranial neuropathies, mass lesions in the brain or spinal cord, aseptic meningitis, and peripheral neuropathy.
What laboratory finding is commonly associated with granulomatous inflammation in the liver due to sarcoidosis?
An increase in serum alkaline phosphatase occurs in approximately 33% of patients with liver involvement in sarcoidosis.
What is the term for granulomatous inflammation in the eyes associated with sarcoidosis, and what are its potential complications?
This condition is called ocular sarcoidosis. Potential complications include glaucoma, cataracts, and vision loss.
What are the potential complications of granulomatous inflammation in the heart due to sarcoidosis?
Granulomatous inflammation in the heart can lead to cardiac arrhythmias, left ventricular dysfunction, and congestive heart failure.
What laboratory finding is commonly associated with granulomatous inflammation in the kidneys due to sarcoidosis?
Hypercalcemia and hypercalciuria are commonly associated with granulomatous inflammation in the kidneys in sarcoidosis.
What is the term for the syndrome that includes fever, parotid gland enlargement, facial palsy, and anterior uveitis in sarcoidosis?
This syndrome is called Heerfordt syndrome.
What is the most common ocular manifestation of sarcoidosis, and what are its potential complications?
The most common ocular manifestation is uveitis, which can lead to complications such as glaucoma and cataracts.
What role do activated T cells play in the pathogenesis of sarcoidosis?
Activated T cells release IL-2 and chemotactic factors that recruit monocytes and macrophages to the site of disease activity. They also expand various T-cell clones, and IFN-γ further activates macrophages, transforming them into giant cells. TNF-α, IL-2, and other cytokines may also stimulate macrophages.
What infectious agents are associated with sarcoidosis, and how do patients respond to treatment?
Infectious agents such as mycobacteria, Propionibacterium acnes, and Chlamydia are associated with sarcoidosis. However, patients with sarcoidosis improve with immunosuppressive agents, suggesting that the etiology is not purely infectious.
What environmental factors are linked to an increased risk of developing sarcoidosis?
Environmental factors associated with an increased risk of developing sarcoidosis include exposure to mineral dusts such as silica, iron, and titanium. Additionally, firefighters and individuals with wood burning stoves are documented as having a higher risk.
How does genetics influence susceptibility to sarcoidosis?
Genetics play a major role in determining susceptibility to sarcoidosis. Relatives of an affected person are more likely to develop the disease than the general population. Additionally, mutations in genes related to the immune system, such as those encoding TNF, lymphotoxin α, and the IL-23 receptor, are associated with different presentations of sarcoidosis.
What are the key components required for the diagnosis of sarcoidosis?
The diagnosis of sarcoidosis requires:
1. A compatible clinical picture
2. Histologic demonstration of noncaseating granulomas
3. Exclusion of other diseases that can produce similar histology or clinical features
As sarcoidosis is a diagnosis of exclusion, it can never be confirmed with 100% certainty.
Why is the presence of noncaseating granulomas in a single organ system not sufficient for diagnosing sarcoidosis?
The presence of noncaseating granulomas in a single organ system does not conclusively establish the diagnosis of sarcoidosis because sarcoidosis is, by definition, a systemic disease that involves multiple organs.
What is the significance of elevated serum angiotensin-converting enzyme (SACE) levels in the diagnosis of sarcoidosis?
Elevated SACE levels reflect the total granuloma burden in sarcoidosis. However, they are insufficiently specific for the diagnosis and should not be relied upon alone. Initial SACE levels do not differ significantly between patients who deteriorate and those who improve, making them unsuitable for treatment determination. Serial SACE levels may be useful for monitoring the course of sarcoidosis, but this test is not routinely used.
What are the stages of pulmonary radiographs in sarcoidosis?
The stages of pulmonary radiographs in sarcoidosis are as follows:
1. Stage 0: Normal
2. Stage I: Bilateral hilar and/or paratracheal adenopathy
3. Stage II: Adenopathy with pulmonary infiltrates
4. Stage III: Pulmonary infiltrates only
5. Stage IV: Pulmonary fibrosis
What are the clinical implications of the panda sign and lambda sign in sarcoidosis diagnosis?
The panda sign (bilateral lacrimal and parotid gland uptake) and lambda sign (bilateral hilar and right paratracheal uptake) on gallium-67 scanning are highly specific for sarcoidosis. Their presence may eliminate the need for invasive diagnostic procedures, although these signs are only positive in a small percentage of sarcoidosis patients.
What histological features are characteristic of sarcoidal granulomas?
Sarcoidal granulomas typically contain:
- A compact collection of mononuclear phagocytes.
- A paucity of lymphocytes, often referred to as ‘naked granulomas’.
- Epithelioid cells, which are transformed monocytes, commonly present within the granuloma.
- Multinucleated giant cells of the Langerhans type resulting from the fusion of epithelioid cells.
What does elevated serum angiotensin-converting enzyme (SACE) levels indicate in sarcoidosis, and what are the limitations of this test?
Elevated SACE levels reflect the total granuloma burden in sarcoidosis. However, the test is insufficiently specific for diagnosis and insufficiently sensitive to exclude the disease.
Is histologic confirmation required for asymptomatic patients with bilateral hilar adenopathy on a chest radiograph?
Histologic confirmation may not be required in asymptomatic patients with bilateral hilar adenopathy if the physical examination, complete blood count, and routine blood tests are normal, and there is no prior history of malignancy.
What is the staging of pulmonary radiographs for sarcoidosis?
The staging of pulmonary radiographs for sarcoidosis is as follows: Stage 0: normal, Stage I: bilateral hilar and/or paratracheal adenopathy, Stage II: adenopathy with pulmonary infiltrates, Stage III: pulmonary infiltrates only, Stage IV: pulmonary fibrosis.
What is the radiographic finding of bilateral hilar adenopathy in sarcoidosis?
The radiographic finding of bilateral hilar adenopathy is a hallmark of sarcoidosis and is noted in 50% to 85% of cases.
What is the general prognosis of sarcoidosis regarding its granulomatous inflammation?
The granulomatous inflammation of sarcoidosis can remit spontaneously or with therapy, leading to a generally good prognosis.
What percentage of patients with pulmonary sarcoidosis experience resolution, improvement, or stabilization without treatment?
60% to 90% of patients with pulmonary sarcoidosis experience resolution, improvement, or stabilization without treatment.
What are the implications of skin lesions in patients with sarcoidosis?
Patients with cutaneous lesions are more likely to have chronic systemic sarcoidosis than those without skin involvement. Skin lesions are not a reliable indicator of prognosis.
What factors indicate the need for treatment of cutaneous sarcoidosis?
Treatment should be considered when lesions are cosmetically unacceptable, scarring, infiltrative as in lupus pernio, or when there are pulmonary symptoms, worsening pulmonary function, neurologic involvement, ocular involvement, or symptomatic cardiac issues.
What is the significance of lupus pernio in sarcoidosis?
Lupus pernio indicates chronic disease and is associated with upper respiratory tract involvement, pulmonary fibrosis, and bony cysts.
What is the significance of erythema nodosum in terms of prognosis in sarcoidosis?
Erythema nodosum with fever and arthralgia portends a good prognosis in sarcoidosis.
What systemic involvement is commonly associated with lupus pernio in sarcoidosis?
Lupus pernio is commonly associated with upper respiratory tract involvement, pulmonary fibrosis, and bony cysts.
What is the recommended initial dose of systemic corticosteroids for pulmonary sarcoidosis?
The recommended initial dose of pulmonary sarcoidosis is 20 to 40 mg of prednisone equivalent per day.
What are the typical doses of methotrexate for cutaneous sarcoidosis?
Typical doses of methotrexate for cutaneous disease are 10 to 25 mg/week.
What is the role of topical tacrolimus in the treatment of cutaneous sarcoidosis?
Topical tacrolimus may be effective for skin disease and does not pose the same adverse effects as corticosteroids, but it is not generally as effective.
What should be monitored when using methotrexate as a treatment for sarcoidosis?
Methotrexate requires careful monitoring of liver function tests and blood cell counts.
What is the tapering guideline for corticosteroid dosage in sarcoidosis treatment?
The corticosteroid dosage is typically tapered by 0.1 to 0.2 mg/kg over a few months, and an attempt should be made to taper the dose within 9 to 12 months of the initiation of therapy.
What are the potential uses of antimalarial drugs in sarcoidosis treatment?
Antimalarial drugs are useful for sarcoidosis affecting the joints and skin, and for managing hypercalcemia.
What is the recommended initial treatment for lupus pernio in sarcoidosis?
Lupus pernio may be improved with prolonged application of class I topical steroids such as clobetasol ointment or intralesional injections of triamcinolone.
What are the monitoring requirements for a patient with sarcoidosis being treated with methotrexate?
Methotrexate requires careful monitoring of liver function tests and blood cell counts. Liver biopsies should be considered after 1 to 2 g of total therapy.
What is the recommended initial dose of systemic corticosteroids for a patient with severe pulmonary symptoms due to sarcoidosis?
The recommended initial dose of systemic corticosteroids for pulmonary sarcoidosis is 20 to 40 mg of prednisone equivalent per day.
What are the potential side effects of antimalarial agents used in the treatment of pulmonary sarcoidosis?
Antimalarial agents are not highly effective for pulmonary disease and can take several months to show effectiveness. Chloroquine has a higher potential for causing retinal damage than hydroxychloroquine, necessitating regular ophthalmologic exams for patients. Additionally, hemolytic anemia may occur, particularly in patients with glucose-6 phosphate dehydrogenase deficiency, although this deficiency is not an absolute contraindication for hydroxychloroquine usage at usual dermatologic doses.
What is the role of cyclophosphamide in the treatment of sarcoidosis?
Cyclophosphamide is effective for many forms of sarcoidosis but is reserved for severe or potentially life-threatening cases due to its significant side-effect profile, including carcinogenic potential.
Which antibiotics have been reported to improve skin sarcoidosis, and what is their effectiveness timeline?
Minocycline and doxycycline (doses of 100 mg twice daily) have been reported to improve skin sarcoidosis in case series, with effectiveness potentially taking up to 2 years. Additionally, the CLEAR regimen (combined levofloxacin, ethambutol, azithromycin, and rifampin) has shown some effectiveness, with ongoing clinical trials to assess its usefulness.
What are some tumor necrosis factor antagonists studied for sarcoidosis, and what is their specific utility?
Pentoxifylline, thalidomide, infliximab, and adalimumab are the most studied tumor necrosis factor antagonists. Infliximab appears particularly useful for the treatment of lupus pernio and may be superior to other TNF antagonists. However, etanercept has failed to show benefit for sarcoidal uveitis.
What procedures have been used to mitigate cutaneous sarcoidosis?
Procedures such as phototherapy, photodynamic therapy, electrodessication, pulse-dye laser therapy, carbon dioxide laser therapy, and reconstructive surgical procedures have all been used successfully to improve the cosmetic disfigurement associated with cutaneous sarcoidosis.
Incidence / prevalence of sarcoidosis is mostly seen in?
- 3rd decade of life
- Women (slightly higher), African American (tend to have more severe and extrapulmonary disease)
- Higher incidence with greater distance from the equator
Papular lesions of sarcoidosis occur most commonly in the?
Face and neck, periorbital skin
Most common complaint for papular lesions?
Cosmetic disfigurement (typically aymptomatic)
Most common form of sarcoidosis?
Papular
Apple jelly sign may be seen in which conditions aside from sarcoidosis?
GA
LV
Form of sarcoidosis with nodules on the extremities?
Darier-Roussy Sarcoid
Nail findings of sarcoidosis due to granulomas in the nail matrix and adjacent bone?
Clubbing
Subungual hyperkeratosis
Nail plate destruction
Form of sarcoidosis occurring primarily in darkly pigmented persons?
Hypopigmented macules
Form of sarcoidosis with symmetric, violaceous, indurated plaques and nodules and a high incidence of systemic involvement and upper respiratory disease?
Lupus pernio
Lupus pernio is most commonly seen is what locations?
nose, earlobes, cheeks, and digits
What type / presentation of sarcoidosis?
Mikulicz syndrome
What type / presentation of sarcoidosis?
Lofgren syndrome
What type / presentation of sarcoidosis?
Heerfordt syndrome
Main nonspecific cutaneous manifestation of sarcoidosis?
Erythema nodosum
Most common noncutaneous lesions of sarcoidosis involve what organ system?
Pulmonary (fibrosis, hypertension and chronic aspergillus)
Most common lesion of ocular sarcoidosis?
Uveitis
Most common nerve involved in neurosarcoidosis?
Facial nerve (cranial neuropathies are the most common manifestation)
Infectious agents associated with sarcoidosis?
Mycobacteria
Proprionibacterium acnes
Chlamydia
Mineral dusts associated with sarcoidosis?
Silica
Iron
Titanium
T or F: Lifelong smokers are more likely to
develop the disease than nonsmokers.
False. Lifelong nonsmokers are more likely to
develop the disease than smokers.
___ levels reflect the total granuloma burden in sarcoidosis. It should not be used to determine treatment but may be useful for monitoring the course of sarcoidosis.
SACE
Remissions often occur within the first 6 months after diagnosis, although it may take _____.
2 to 5 years
Form of sarcoidosis with >80% rate of spontaneous remission, generally within 4 to 6 weeks.
Lofgren syndrome
Factors linked to worse prognosis?
IL triamcinolone strength for sarcoidosis?
2.5 - 10 mg/ml
Describe the treatment algorithm for cutaneous sarcoidosis.
Enumerate the medical therapy for sarcoidosis.
