Location
Suwanee, GA
Start Date
6-5-2025 1:00 PM
End Date
6-5-2025 4:00 PM
Description
Introduction
Sarcoidosis is a granulomatous skin condition of unknown etiology, which is diagnostically challenging because it can mimic various skin conditions. In this review, we report the case of a 59-year-old male presenting with previously undiagnosed cutaneous sarcoidosis in the form of alopecia and atrophic plaques on his scalp that clinically resembled necrobiosis lipoidica (NL).
Objectives
The primary objective of this study is to compare the treatment outcomes of our case report along with other existing cases of NL-like sarcoidosis.
Case Report
A 59-year-old male patient exhibited a shiny pink-yellow atrophic plaque with crusting, telangiectasias, and secondary alopecia. With a suspicion of NL, a biopsy was obtained to rule out morpheaform basal cell carcinoma. Instead, pathology results reported sarcoidosis, substantiated by the naked granulomas under histology. Further laboratory and imaging studies did not indicate any systemic involvement. The patient used fluocinonide solution 0.05% twice daily and returned with normal-appearing skin 3 years after the diagnosis.
Methods
A literature search was conducted on Pubmed for articles published between 1980 and 2024, which gathered 60 patients obtained from 15 different articles who presented with NL-like sarcoidosis.
Results
Lesions distributed on the head presented in 41.67% of the patients from the literature, similar to our patient. In contrast to the lesion improvement in our patient with topical steroids, 13 patients from the literature had no improvement. Instead, the combination of oral thalidomide and hydroxychloroquine demonstrated the best efficacy, treating 100% of patients (7/7 patients), followed by oral prednisone treating 75% of patients (6/8 patients).
Discussion
Limitations of this review include the small sample size of our literature search, which may be due to the diagnostic challenges of delineating between NL and cutaneous sarcoidosis, causing subsequent deficiency in reporting. Immunohistochemistry has identified glioma-associated oncogene-1 (GLI-1) in both conditions, suggesting that direct GLI-1 inhibitors may be of potential use. Tacrolimus has been demonstrated to indirectly inhibit GLI-1 expression, with reports of it treating both conditions.
Conclusion
The multitude of conditions that cutaneous sarcoidosis may mimic leads to frustration for both the clinician and patient in pursuing the correct diagnosis and appropriate treatment. While uncommon, atrophic sarcoidosis appears on the scalp or face in almost half of the cases, and topical corticosteroids usually have no effect. The combination of oral thalidomide and hydroxychloroquine seem to have a good outcome, however, further research is warranted to overcome diagnostic challenges when cutaneous sarcoidosis has NL-like features.
Embargo Period
5-28-2025
Included in
Cutaneous sarcoidosis imitating necrobiosis lipoidica: a case report and review
Suwanee, GA
Introduction
Sarcoidosis is a granulomatous skin condition of unknown etiology, which is diagnostically challenging because it can mimic various skin conditions. In this review, we report the case of a 59-year-old male presenting with previously undiagnosed cutaneous sarcoidosis in the form of alopecia and atrophic plaques on his scalp that clinically resembled necrobiosis lipoidica (NL).
Objectives
The primary objective of this study is to compare the treatment outcomes of our case report along with other existing cases of NL-like sarcoidosis.
Case Report
A 59-year-old male patient exhibited a shiny pink-yellow atrophic plaque with crusting, telangiectasias, and secondary alopecia. With a suspicion of NL, a biopsy was obtained to rule out morpheaform basal cell carcinoma. Instead, pathology results reported sarcoidosis, substantiated by the naked granulomas under histology. Further laboratory and imaging studies did not indicate any systemic involvement. The patient used fluocinonide solution 0.05% twice daily and returned with normal-appearing skin 3 years after the diagnosis.
Methods
A literature search was conducted on Pubmed for articles published between 1980 and 2024, which gathered 60 patients obtained from 15 different articles who presented with NL-like sarcoidosis.
Results
Lesions distributed on the head presented in 41.67% of the patients from the literature, similar to our patient. In contrast to the lesion improvement in our patient with topical steroids, 13 patients from the literature had no improvement. Instead, the combination of oral thalidomide and hydroxychloroquine demonstrated the best efficacy, treating 100% of patients (7/7 patients), followed by oral prednisone treating 75% of patients (6/8 patients).
Discussion
Limitations of this review include the small sample size of our literature search, which may be due to the diagnostic challenges of delineating between NL and cutaneous sarcoidosis, causing subsequent deficiency in reporting. Immunohistochemistry has identified glioma-associated oncogene-1 (GLI-1) in both conditions, suggesting that direct GLI-1 inhibitors may be of potential use. Tacrolimus has been demonstrated to indirectly inhibit GLI-1 expression, with reports of it treating both conditions.
Conclusion
The multitude of conditions that cutaneous sarcoidosis may mimic leads to frustration for both the clinician and patient in pursuing the correct diagnosis and appropriate treatment. While uncommon, atrophic sarcoidosis appears on the scalp or face in almost half of the cases, and topical corticosteroids usually have no effect. The combination of oral thalidomide and hydroxychloroquine seem to have a good outcome, however, further research is warranted to overcome diagnostic challenges when cutaneous sarcoidosis has NL-like features.