Sarcoidosis

Question 1

Primarily affecting what organ

Answer 1

lungs (bilateral lymphadenopathy and pulmonary in lnfiltration)

Question 2

Skin lesions.

Answer 2

Papules, translucent yellow-red with apple jelly appearance on diascopy; nodules and bluish-red plaques.

Question 3

most common nonspecific lesion in the skin in early sarcoidosis. Means good prognosis.

Answer 3

Eythema nodosum

Question 4

Age
Sex
place

Answer 4

Under 40
Equal
Scandanavia

Question 5

Skin lesions

Answer 5

Earliestlesionsareskin-colored orbrownishpapules,occurringperiori cially on the ace (Fig. 14-66). Brownish or purple
in ltratedplaquesthatmaybeannular,poly- cyclic, serpiginous, and occur mainly on the extremities, buttocks, and trunk (Fig. 14-67). Central clearing with slight atrophy may occur. Occasionally, nodules, rm, purple or browny

may arise on the ace, trunk, or extremities, particularlythehands.Lupuspernio:Di use, violaceous, so doughy in ltrations on the nose, cheeks (Fig. 14-68), or earlobes. Swelling o individualdigitsbecauseo osteitiscystica (Fig.14-69).Sarcoidosistendstoin ltrate
old scars, which then exhibit translucent purple-red or yellowish papules or nodules (Fig. 14-70). Note: On blanching with glass slide,allcutaneouslesionso sarcoidosisreveal “apple jelly” semitranslucent yellowish brown color. On the scalp, sarcoidosis may cause scar- ring alopecia

Question 6

Diffuse, violaceous, so doughy infiltrations on the nose, cheeks or earlobes

Answer 6

Lupus pernio

Question 7

Blanching on glass shows….

Answer 7

apple jelly” semitranslucent yellowish brown color

Question 8

Dermatopathology

Answer 8

Large islands of epithelioid cells with a few giant cells and lymphocytes (so- called naked tubercles). Asteroid bodies in large histiocytes; occasionally fibrinoid necrosis

Question 9

Findings on imaging.

Answer 9

In 90% of patients:Hilar lymphadenopathy ,pulmonary infiltrate.Cystic lesions in phalangeal bones(osteitis cystica)

Question 10

Blood chemistry findings:

Answer 10

Increased level of serum angiotensin-converting enzyme,
hypergamma- globulinemia,
hypercalcemia.

Question 11

Best criterion for diagnosis of sarcoidosis

Answer 11

Lesional biopsy of skin or lymph infection nodes

Question 12

Treatment

Answer 12

SYSTEMICSARCOIDOSIS Systemicglucocorticoids oractiveoculardisease,activepulmonary
disease, cardiac arrhythmia, CNS involvement, or hypercalcemia.
CUTANEOUSSARCOIDOSIS Glucocorticoids. Local: Intralesionaltriamcinolone,3mg/mL, e ective orsmalllesions.Systemic:Glucocor- ticoids or widespread or dis guring involve- ment.
Hydroxychloroquine. 100mgtwicedaily or widespreadordis guringlesionsreractoryto intralesional triamcinolone. Only sometimes e ective.
Methotrexate. Low-dose or widespread skin and systemic involvement, although not always e ective. Cyclophosphamide is used only or potentially li e-threatening disease. Anti-TNF-α Agents,includingthalidomide (monitor ortuberculosis).