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Skin rashes associated with pulmonary sarcoidosis. Sarcoidosis of the skin

Doctors call sarcoidosis a disease of a systemic nature, in which many tissues and organs of the body are affected, but the lungs and lymphatic system are most affected by pathology. Destructive processes caused by the development and progression of sarcoidosis are observed in patients of all age categories and social classes, so the question of which doctor treats sarcoidosis is considered popular and relevant in society. Doctors identify common foci of connective tissue as the defining symptom for this pathology. inflammatory in nature, that is, the formation of granulomas. Experts usually detect multiple nodules in tissues lymph nodes, liver, spleen, myocardium, skin and muscles. The disease often occurs without significant symptoms for a year or several years, and then regresses on its own, and the granulomas disappear. There are also severe forms of sarcoidosis, which are characterized by characteristic features and symptoms.

Etiology

The etiology of sarcoidosis is not fully understood, however, doctors identify the following etiotropic factors of the disease::

  • heredity;
  • smoking;
  • air polluted with salts of heavy metals.

Sarcoidosis of the lungs is treated by a pulmonologist who identifies some infectious diseases, as a trigger for systemic pathology, for example, tuberculosis, viral hepatitis, herpes.


When diagnosing sarcoidosis, doctors differentiate it from tuberculosis or metastasis to the lung tissue of a neoplasm, since the clinical picture and results X-ray studies have significant similarities. Consequently, doctors such as a therapist, oncologist, phthisiatrician, pulmonologist and radiologist take part in this process. Experts prescribe magnetic resonance or computed tomography as the most informative method for making an accurate diagnosis.

Clinic of the disease

90-95% of patients have pulmonary pathology. Symptoms very often have a faded course or are completely absent. In case of sarcoidosis, they consult a doctor who clarifies the following subjective complaints of the patient and identifies the following physiological abnormalities:

  • general weakness;
  • severe fatigue;
  • increase in temperature;
  • muscle and joint pain;
  • persistent cough;
  • chest pain;
  • hemoptysis is diagnosed in very rare cases.

Sarcoidosis very often heals on its own. In other cases, the doctor prescribes traditional methods of treatment or medications.

General sarcoidal damage to the body occurs in several variants. Sarcoidosis of the skin in this case, it is manifested by the formation of tuberculate seals on the skin. The disease is often accompanied by the formation of granulomas in the lung tissues and regional lymph nodes.

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What are the reasons for the development?

The exact etiology of the disease has not been clarified. In the recent past, doctors have associated sarcoidosis with manifestations of tuberculosis. Today, scientists have determined that these are two completely different diseases.

Many modern studies have determined key role hereditary mutations DNA in the occurrence of sarcoidosis lesions of the epidermis. In addition, contribute to the development of pathology skin The following risk factors may include:

  1. Chronic injury to the skin.
  2. Ultraviolet irradiation of the epidermis.
  3. Constant human contact with toxic substances that can be found in everyday life and at work.
  4. Abuse of strong alcoholic drinks and smoking.

Pathogenesis of the disease

The disease begins with the formation of small nodes of atypical compaction of epithelial tissue. Subsequently, in the growth area of ​​the tumor, redness and itching of the skin is noted, which ends in the formation of an inflammatory granuloma.

Cutaneous sarcoidosis is characterized by the gradual fusion of the primary elements of the lesion. Multiple sarcoidomas gradually increase in size and cause significant discomfort to the person.

Clinical picture and early signs

IN medical practice It is customary to divide the disease into two forms:

  1. Small nodular pathology - such nodular growth of the epidermis is limited to red or cyanotic areas of the skin. The size of the neoplasm is 5-6 mm. The surface of the granuloma is smooth.
  2. Coarse-grained pathology - in such cases, the compaction grows to 1-2 cm in diameter. Granuloma has a reddish or brown surface.

Disease long time may not cause any subjective sensations in the patient. The skin completely covers the formation, which is accompanied by increased peeling of the skin and itching.

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How dangerous is sarcoidosis of the skin?

The disease does not pose a direct threat to the patient's life. Negative consequences of the disease can be considered the spread of pathology to the lungs, spleen and regional lymph nodes.

Granulomatous lesions of the skin, in addition to aesthetic discomfort, can provoke chronic injury to the epidermis.

What is included in the diagnosis?

The cutaneous form of the disease is quite rare. In this regard, diagnostics should be carried out qualified specialist. The procedure for examining a patient consists of the following procedures:

  1. Collecting anamnesis of the disease and determining family predisposition.
  2. Visual inspection and palpation of the atypical area. At this stage, the doctor determines the size, consistency and degree of mobility of the granuloma.
  3. General and biochemical blood test.
  4. Mantoux test, which allows you to exclude the development of tuberculosis.
  5. X-ray examination of the respiratory system and abdominal organs.
  6. Biopsy. In doubtful clinical cases doctors resort to histological and cytological examination of a small part of the pathological area.

Modern treatment

Treatment of skin manifestations of this disease starts with drug therapy in the form:

  1. Taking a course of non-steroidal anti-inflammatory drugs.
  2. Vitamin therapy. Doctors pay special attention to vitamins A and E.

This therapy is symptomatic. In some cases, the patient needs to switch to taking hormonal drugs such as Hydrocortisone and Prednisolone.

Strengthening the therapeutic effect medications achieved by physiotherapy methods. The most effective methods are:

  1. Laser therapy – laser radiation stimulates the restoration of damaged epidermal tissue and enhances local microcirculation. As a result, formations decrease.
  2. Electrophoresis with hormonal drugs. Doctors use microcurrents to precisely inject hydrocortisone into the pathological area of ​​the skin.
  3. Iontophoresis of anti-inflammatory drugs. Deep penetration medicinal products increases the effectiveness of therapy several times.

Folk remedies

Cutaneous sarcoidosis is considered a serious disease that should be treated by an experienced specialist. A positive treatment result can only be observed if the patient stays in a medical facility.

Traditional medicine in such cases is used as additional method stimulation of the immune system. Activation of the body's protective abilities is carried out with the help of tinctures and decoctions of marshmallow root, rose hips, viburnum, currants and calendula.

Complications that can result from cutaneous sarcoidosis

Negative consequences of sarcoidosis lesions of the skin are observed in the following forms:

  1. Spontaneous bleeding. An increase in the volume of cutaneous granuloma can cause traumatic injury a nearby blood vessel, which is clinically manifested by bleeding. In most cases, this complication does not require specialized medical care.
  2. The spread of the pathological process to the lungs, which can result in fibrosis. This condition of the body is characterized by the replacement of lung tissue with fibrous tissue.
  3. In some patients, the disease is accompanied by the formation of kidney stones due to increased calcium levels in the blood.

Does skin sarcoidosis turn into cancer?

Cutaneous sarcoidosis is not precancerous condition and, accordingly, cannot cause the formation of a cancerous tumor.

Forecast

The cutaneous form of the disease usually has a favorable prognosis. Sarcoidosis of the lungs and cardiovascular system. Patients should take into account that most epidermal granulomas are accompanied by the spread of the pathological process to the internal organs.

Reasons deaths can serve:

  • spontaneous internal bleeding;
  • development of acute respiratory and heart failure;
  • urolithiasis.

In medical practice, it is customary to distinguish between the following risk factors that aggravate the course of the disease:

  1. Extremely slow progression of pathology when the patient is diagnosed with a chronic course of systemic granulomatosis.
  2. Involvement of pulmonary, cardiovascular and nervous tissues in the pathological process.
  3. X-ray examination reveals a late stage of the disease.
  4. Increasing symptoms of respiratory and heart failure.

Sarcoidosis of the skin can be prevented by a healthy lifestyle, undergoing annual preventive examinations, regular physical exercise, quitting smoking, timely diagnosis disease and treatment of symptoms of granulomatosis.

Sarcoidosis is a systemic disease that can affect various organs and tissues, but most often affects respiratory system. The first mentions of this pathology date back to the beginning of the 19th century, when the first attempts were made to describe the pulmonary and cutaneous form of the disease. Sarcoidosis is characterized by the formation of specific granulomas, which are the main problem. The reasons for the development of this disease are currently unknown, despite large number research done in this area.

Sarcoidosis occurs throughout the world and on all continents, but its prevalence is uneven. It is presumably influenced by both climatic conditions and genetic racial characteristics. Among African Americans, for example, the prevalence of sarcoidosis is about 35 cases per 100,000 population. At the same time, among the light-skinned population of North America, this figure is 2–3 times lower. In Europe, in recent years, the prevalence of sarcoidosis has been approximately 40 cases per 100,000 population. The lowest rates ( only 1 – 2 cases) are celebrated in Japan. The highest data are recorded in Australia and New Zealand ( from 90 to 100 cases).

Sarcoidosis can affect people of any age, but there are certain critical periods during which the incidence is highest. The age from 20 to 35 years is considered dangerous for both sexes. In women, there is a second peak in incidence, which occurs from 45 to 55 years. In general, the likelihood of developing sarcoidosis is approximately the same for both sexes.

Causes of sarcoidosis

As mentioned above, the root causes that give impetus to the development of sarcoidosis are: at the moment not installed. More than a hundred years of research into this disease have led to the emergence of a number of theories, each of which has certain grounds. Basically, sarcoidosis is associated with exposure to certain external or internal factors which occurred in most patients. However, a common factor for all patients has not yet been identified.

The following theories exist regarding the occurrence of sarcoidosis:

  • infectious theory;
  • theory contact transmission illness;
  • exposure to environmental factors;
  • hereditary theory;
  • drug theory.

Infection theory

The infectious theory is based on the assumption that the presence of certain microorganisms in the human body can trigger a disease. This is explained as follows. Any microbe entering the body causes an immune response, which consists of the production of antibodies. These are specific cells aimed at fighting this microbe. Antibodies circulate in the blood, so they reach almost all organs and tissues. If a certain type of antibody continues to circulate for a very long time, it can affect some biochemical and cellular reactions in the body. In particular, this concerns the formation of special substances - cytokines, which are involved in many physiological processes under normal conditions. If a person has a genetic or personal predisposition, he will develop sarcoidosis.

The risk of sarcoidosis is thought to increase in people who have had the following infections:

  • Mycobacterium tuberculosis. tuberculosis. Its influence on the occurrence of sarcoidosis is explained by a number of interesting facts. For example, both of these diseases primarily affect the lungs and pulmonary lymph nodes. In both cases, granulomas are formed ( special clusters of cells of various sizes). Finally, according to some data, antibodies to tuberculosis can be detected in almost 55% of patients with sarcoidosis. This suggests that patients have ever encountered mycobacteria ( have had latent tuberculosis or been vaccinated). Some scientists are even inclined to consider sarcoidosis a special subspecies of mycobacteria, but this assumption does not yet have convincing evidence, despite numerous studies.
  • Chlamydia pneumoniae. This microorganism is the second most common causative agent of chlamydia ( after Chlamydia trachomatis), which mainly causes damage to the respiratory system. The hypothesis about the connection of this disease with sarcoidosis appeared after special research. It compared the prevalence of chlamydia antigens in the average healthy people and in patients with sarcoidosis. The study showed that anti-chlamydial antibodies were almost twice as common in the study group of patients. However, no evidence of Chlamydia pneumoniae DNA was found directly in tissue from sarcoid granulomas. This, however, does not exclude that bacteria only trigger the development of the disease according to a hitherto unknown mechanism, without directly participating in the development of sarcoidosis.
  • Borrelia burgdorferi. This microorganism is the causative agent of Lyme disease ( tick-borne borreliosis ). Its role in the development of sarcoidosis was discussed after a study conducted in China. Antibodies to Borrelia burgdorferi were detected in 82% of patients with sarcoidosis. However, live microorganisms were detected in only 12% of patients. This also suggests that Lyme borreliosis may precipitate the development of sarcoidosis, but is not required for its development. This theory is contradicted by the fact that borreliosis has a limited geographical distribution, while sarcoidosis is found everywhere. Therefore, a similar study in Europe and North America showed a lower dependence of sarcoidosis on the presence of antibodies against Borrelia. In the Southern Hemisphere, the prevalence of borreliosis is even lower.
  • Propionibacterium acnes. Bacteria of this species are conditionally pathogenic and are present on the skin and in the gastrointestinal tract ( gastrointestinal tract ) healthy people, without showing themselves in any way. A number of studies have shown that almost half of patients with sarcoidosis have an abnormal immune response against these bacteria. Thus, a theory has emerged about the genetic predisposition of the immune system to the development of sarcoidosis upon contact with Propionibacterium acnes. The theory has not yet received unequivocal confirmation.
  • Helicobacter pylori. Bacteria from this genus play big role in the development of gastric ulcers. A number of studies in the United States have found that the blood of patients with sarcoidosis contains increased amount antibodies to these microorganisms. This also suggests that the infection may be triggering immune reactions leading to the development of sarcoidosis.
  • Viral infections. Similarly with bacterial infections, the possible role of viruses in the occurrence of sarcoidosis is considered. In particular, we're talking about about patients with antibodies to rubella, adenovirus, hepatitis C, as well as about patients with herpes viruses various types (including Epstein-Barr virus). Some evidence even suggests that viruses may play a role in the development of the disease, not just in triggering autoimmune mechanisms.
Thus, many different studies have indicated the possible role of microorganisms in the occurrence of sarcoidosis. At the same time, there is no single infectious agent, the presence of which would be confirmed in 100% of cases. Therefore, it is generally accepted that a number of microbes only make some contribution to the development of the disease, being risk factors. However, other factors must be present for sarcoidosis to occur.

Theory of contact transmission of disease

This theory is based on the fact that a significant proportion of people who develop sarcoidosis have previously been in contact with patients. According to various sources, such contact is present in 25–40% of all cases. Familial cases are also often observed, when within one family the disease develops in several of its members. In this case, the time difference can be years. This fact may simultaneously indicate genetic predisposition, the possibility of an infectious nature and the role of factors external environment.

The theory of contact transmission itself appeared after an experiment on white mice. During it, several generations of mice were successively reseeded with cells from sarcoid granulomas. After some time, the mice that received a dose of pathological cells began to show signs of disease. Irradiation or heating of cell cultures destroyed their pathogenic potential, and the treated culture no longer caused sarcoidosis. Similar experiments have not been carried out in humans due to ethical and legal norms. However, the possibility of developing sarcoidosis after contact with pathological cells from a patient is accepted by many researchers. Practical proof cases are considered when sarcoidosis developed after organ transplantation from patients. In the USA, where transplantation is most developed, about 10 similar cases have been described.

Impact of environmental factors

May play a role in the development of sarcoidosis production factors. This mainly concerns air hygiene, since most harmful substances enter the lungs with it. Dust in the workplace is a common cause of various occupational diseases. Because sarcoidosis primarily affects the lungs, a number of studies have been conducted to determine the role of occupational factors in the development of the disease.

It turned out that among people who frequently come into contact with dust ( firefighters, rescuers, miners, grinders, publishing and library workers), sarcoidosis is almost 4 times more common.

Particles of the following metals play a special role in the development of the disease:

  • beryllium;
  • aluminum;
  • gold;
  • copper;
  • cobalt;
  • zirconium;
  • titanium.
Beryllium dust, for example, when in large quantities enters the lungs, leads to the formation of granulomas, which are very similar to granulomas in sarcoidosis. It has been proven that other metals can disrupt metabolic processes in tissues and activate immune system.

Among household environmental factors not associated with occupational risk, the possibility of the influence of various molds when they enter the lungs with air is discussed.

Tests more specific for sarcoidosis are:

  • Angiotensin converting enzyme ( APF). This enzyme is normally produced in various tissues of the body and affects the regulation of blood pressure. The cells that make up granulomas in sarcoidosis have the ability to produce ACE in large quantities. Thus, the level of the enzyme in the blood will be greatly increased. The norm for adults is from 18 to 60 units/l. In children, the test is not informative, since normally the ACE content can fluctuate greatly. Venous blood is taken for analysis, and the patient should not eat for 12 hours before donating it, so as not to distort the results.
  • Calcium. Granulomas in sarcoidosis are capable of producing large amounts of active vitamin D. This form affects calcium metabolism in the body, increasing its performance in almost all tests. Most often with sarcoidosis, calcium in the urine rises ( norm from 2.5 to 7.5 mmol/day). Somewhat later, the level of calcium in the blood rises ( hypercalcemia greater than 2.5 mmol/l). Similar abnormalities can be detected by testing saliva or cerebrospinal fluid, but they do not occur in all patients. It is believed that increased calcium in sarcoidosis indicates the need for active treatment.
  • Tumor necrosis factor alpha ( TNF-α). This substance was discovered relatively recently, but its active participation in many pathological processes has already been proven. Normally, TNF-α is produced by monocytes and macrophages. Both of these types of cells work in an enhanced mode in sarcoidosis. Thus, in patients, the analysis will show an increase in the level of this protein in the blood.
  • Kveim-Siltsbach test. This test confirms the diagnosis of sarcoidosis with a high degree of accuracy. A small amount of lymphatic tissue affected by sarcoidosis is injected into the patient's skin to a depth of 1–3 mm. The drug is prepared in advance from the spleen or lymph nodes. In a patient, the administration of the drug will cause the formation of a small bubble protruding above the surface of the skin. At the injection site, characteristic granulomas quickly begin to form. Despite the high accuracy of the test, it is used extremely rarely these days. The fact is that there is no uniform standard for preparing the drug. Because of this, there is a high risk of introducing other diseases to the patient during the test ( viral hepatitis, HIV, etc.).
  • Tuberculin test. The tuberculin test or Mantoux test is the most important way to detect tuberculosis infection. It is considered a mandatory test for all patients with suspected sarcoidosis. The fact is that pulmonary forms of tuberculosis and sarcoidosis are very similar in symptoms, but require different treatments. For sarcoidosis tuberculin test negative in more than 85% of cases. However, this result cannot definitively exclude the diagnosis. Carrying out the Mantoux test involves introducing tuberculin, a special drug similar to the causative agent of tuberculosis, into the thickness of the skin. If the patient has tuberculosis ( or he had tuberculosis in the past), then after 3 days a red lump with a diameter of more than 5 mm forms at the injection site. Redness of a smaller diameter is considered a negative reaction. In children under 18 years of age, test results may be distorted due to vaccination against tuberculosis.
  • Copper. In almost all patients with pulmonary sarcoidosis, copper levels in the blood begin to rise at some stage of the disease ( the norm for men is 10.99 – 21.98 µmol/l, for women – 12.56 – 24.34 µmol/l). At the same time as copper, the level of the protein containing this element, ceruloplasmin, also increases.

Instrumental diagnosis of sarcoidosis

Instrumental diagnosis of sarcoidosis is aimed primarily at visualizing the pathological process. With its help, doctors try to determine as accurately as possible the organs affected by the pathology. There have often been cases where instrumental studies done for other diseases showed the first signs of sarcoidosis even before the first symptoms appeared. Thus, instrumental diagnostics is, to some extent, a method of active detection of pathology.

Instrumental methods for imaging sarcoidosis


Research method Principle of the method Applications and results in sarcoidosis
Radiography Radiography involves passing x-rays through human tissue. At the same time, particles pass through denser tissues less easily. As a result, it is possible to identify pathological formations in human body. The method involves dosed radiation and has contraindications. The duration of the study and obtaining the result usually takes no more than 15 minutes. For sarcoidosis, fluorography is done - an X-ray of the chest. At a certain stage of the disease, some changes appear in 85–90% of patients with tuberculosis. Most often, there is an increase in lymph nodes in the mediastinum or signs of damage to the lung tissue. The localization of lesions in the image is usually bilateral. X-ray examination is important for determining the stage of the disease, although it often does not allow it to be accurately identified. In extrapulmonary forms of tuberculosis, radiography is used relatively rarely, since pathological formations will be less distinguishable against the background of other tissues.
Computed tomography(CT) The principle of obtaining an image is similar to that of radiography and is also associated with dosed irradiation of the patient. The difference lies in the possibility of layer-by-layer image acquisition, which greatly increases the accuracy of the examination. Modern tomographs make it possible to obtain two-dimensional and three-dimensional images with visualization of small structures, which increases the chances of diagnostic success. The procedure lasts 10–15 minutes, and the doctor receives its results on the same day. Nowadays, computed tomography is recommended to be preferred when sarcoidosis is suspected. It allows you to identify smaller formations and recognize the disease at an earlier stage. The main area of ​​application of CT is in patients with pulmonary sarcoidosis. There is a bilateral increase in all groups of mediastinal lymph nodes. In addition, with an intense inflammatory process, some pulmonary complications of sarcoidosis can be detected. In the chronic course of the disease, CT scans sometimes reveal calcifications - inclusions of calcium salts that isolated the pathological focus.
Magnetic resonance imaging(MRI) MRI involves obtaining a highly accurate three-dimensional image with visualization of very small lesions. The best images are obtained in anatomical areas rich in fluids. The patient is placed inside a huge powerful magnetic field. The duration of the study is 15 – 30 minutes. MRI is almost never used in pulmonary forms of sarcoidosis, which relegates it to the background in the diagnosis of this disease ( after CT). However, MRI is indispensable for atypical locations of sarcoid granulomas. This study is used primarily for neurosarcoidosis to determine the exact location of lesions in the brain and spinal cord. Great value MRI also plays a role in determining damage to the heart and musculoskeletal system.
Radionuclide research(scintigraphy) This study involves the introduction into the patient’s blood of a special active substance, which accumulates in the lesions. For sarcoidosis ( especially in pulmonary forms) prescribe scintigraphy with gallium-67 ( Ga-67). This method The study has certain contraindications and is used relatively rarely. When gallium is introduced into the blood, it actively accumulates in inflammatory foci in the lung tissue. The most intense accumulation occurs precisely in sarcoidosis. It is important that the intensity of accumulation of the substance corresponds to the activity of the disease. That is, in acute sarcoidosis, lesions in the lungs will be clearly visible on the image. At the same time, when chronic course disease, the accumulation of the isotope will be moderate. Given this feature of scintigraphy, it is sometimes prescribed to check the effectiveness of treatment. With correctly selected drugs and dosage, gallium accumulation practically does not occur, which indicates that the active pathological process has stopped.
Ultrasound examination(Ultrasound) An ultrasound scan sends high-frequency sound waves through body tissue. A special sensor detects the reflection of waves from various anatomical structures. Thus, an image is constructed based on the division of body tissues by density. The test usually takes 10 to 15 minutes and does not involve any health risks ( has no absolute contraindications). Ultrasound is prescribed for extrapulmonary forms and manifestations of sarcoidosis. The data obtained through this study only allows us to detect a neoplasm in the thickness of the soft tissues. Other examinations will be needed to determine the origin of this formation. Ultrasound can also be actively used in the diagnosis of complications of tuberculosis ( internal bleeding, kidney stones).

Besides instrumental methods To visualize sarcoidosis, there are a number of studies that allow assessing the functional state of organs. These methods are less common, since they reflect not so much the stage or severity of the disease, but rather the vital functions of the body. However, these methods are important for determining the success of treatment and timely detection of complications of sarcoidosis.

Additional methods instrumental examination with sarcoidosis are:

  • Spirometry. Spirometry is prescribed for pulmonary forms of sarcoidosis on late stages diseases. This method helps determine the functional volume of the lungs. A special device records the maximum volume of air that the patient inhales. With the development of complications of sarcoidosis, vital capacity ( vital capacity) can decrease several times. This indicates a severe course of the disease and a poor prognosis.
  • Electrocardiography. Electrocardiography is used both for cardiac sarcoidosis and for the pulmonary form of the disease. As mentioned above, the functioning of the heart muscle can be impaired in both of these cases. ECG is the fastest and in an accessible way to assess the functional state of the heart. It is recommended to repeat this study several times a year in order to be able to compare the dynamics of changes.
  • Electromyography. Electromyography is sometimes prescribed to detect problems with skeletal muscle function. The study assesses transmission and distribution nerve impulse to muscle fiber. Electromyography may be ordered to help detect early signs of muscle sarcoidosis and neurosarcoidosis. In both cases, there will be a delay in the propagation of the impulse and muscle weakness.
  • Endoscopy. Endoscopic methods involve the use of special miniature cameras that are inserted into the body to detect signs of disease. Widespread, for example, FEGDS ( fibroesophagogastroduodenoscopy). This study helps in the search for sarcoidosis in the upper gastrointestinal tract. It is performed on an empty stomach and requires preliminary preparation of the patient.
  • Fundus examination. Examination of the fundus is a mandatory procedure for the development of uveitis or other types of eye damage in sarcoidosis. All diagnostic procedures related to eye assessment are performed by ophthalmologists.

Treatment of sarcoidosis

Treatment of sarcoidosis is very challenging because different stages and at different forms disease requires the use of various medications. In general, it is believed that it is impossible to completely stop the pathological process. However, in most cases, it is possible to achieve long-term remissions and improve the patient’s life so much that he does not pay attention to his illness.

In the treatment of sarcoidosis important point is an integrated approach. Since no common causes for the development of the disease have been found, doctors try not only to prescribe the correct drug treatment, but also to protect the patient from exposure external factors which can aggravate the course of the disease. In addition, some forms of sarcoidosis and its complications require a separate course of treatment. In this regard, treatment of the disease must be carried out in different directions, depending on the specific clinical case.

  • systemic drug treatment;
  • local drug treatment;
  • surgical treatment;
  • irradiation;
  • diet;
  • prevention of disease complications.

Systemic drug treatment

Systemic drug treatment for sarcoidosis is usually carried out initially in a hospital setting. The patient is hospitalized to confirm the diagnosis and undergo a thorough examination. In addition, some drugs used in the treatment of sarcoidosis have serious side effects. In this regard, it is recommended that blood be taken again for analysis and that doctors monitor the basic functions of the body. After selecting an effective treatment regimen, patients are discharged if there is no threat to life.

Drug treatment of sarcoidosis requires adherence to some basic principles:

  • Patients without obvious symptoms of the disease in whom sarcoidosis is detected at an early stage do not require drug treatment. The fact is that due to limited knowledge about the development of the disease, it is impossible to predict how quickly the process will develop. The risk from intensive treatment may be greater than possible risk from the development of sarcoidosis itself. Sometimes spontaneous remissions of the disease are observed in the second stage of the disease. Therefore, a course of treatment is not always prescribed even to patients with minor violations lung functions.
  • Treatment usually begins with high doses of drugs to reduce the acute symptoms of the disease and thereby improve the quality of life of patients. Subsequently, the dose is reduced in order to only control the onset of symptoms.
  • The mainstay of treatment is corticosteroid drugs, which are given orally ( in tablet form). It is believed that they give good effect at almost any stage of the disease.
  • Long-term use corticosteroids may cause osteoporosis ( softening of bone tissue due to metabolic disorders). In this regard, it is necessary to simultaneously prescribe drugs from the group of bisphosphonates for preventive purposes.
  • In the pulmonary form of sarcoidosis, inhalation ( local) the use of corticosteroids does not provide a better therapeutic effect. They can be prescribed for concomitant reactive inflammatory processes.
  • Other drugs pharmacological groups (other than corticosteroids) are prescribed either in combination with the latter, or if the patient is individually intolerant to corticosteroids.

Standard regimens for systemic treatment of patients with sarcoidosis

Drugs Dosage Therapeutic effect
Monotherapy ( course with one drug)
Glucocorticosteroids (GCS) 0.5 mg/kg body weight per day ( the dose is indicated for prednisolone, which is the main GCS drug used in the treatment). Orally, daily. The dose is reduced gradually as the condition improves. The course of treatment lasts at least six months. GCS have a strong anti-inflammatory effect. They suppress cellular biochemical reactions that are necessary for the formation of granulomas.
Glucocorticosteroids 0.5 mg/kg/day, orally, every other day. The dose is reduced according to the general scheme - once every 6–8 weeks the total daily dose is reduced by 5 mg. The course of treatment lasts 36–40 weeks.
Methotrexate 25 mg once a week, orally. Every other day, 5 mg of folic acid is prescribed to reduce side effects. The course of treatment is 32 – 40 weeks. Inhibits cell growth, suppressing the formation of granulomas and reducing inflammation. In small doses it can be used for a long time, unlike corticosteroids. It is prescribed more often for chronic sarcoidosis.
Pentoxifylline 600 – 1200 mg/day in three doses, orally. The course of treatment is 24 – 40 weeks. The drug is used to replace and gradually reduce the dose of corticosteroid drugs. In addition, it improves the supply of oxygen to tissues, which is used in pulmonary forms of the disease.
Alpha tocopherol 0.3 – 0.5 mg/kg/day, orally, for 32 – 40 weeks. Improves cellular respiration, reduces the likelihood of developing atherosclerosis. In sarcoidosis it is rarely used alone ( often in combination with other drugs).
Combined treatment regimens
Glucocorticosteroids and chloroquine GCS – 0.1 mg/kg/day, orally, without dose reduction.
Chloroquine – 0.5 – 0.75 mg/kg/day, orally. The course of treatment is 32 – 36 weeks.		 Chloroquine suppresses the immune system, affecting the intensity of the inflammatory process. In addition, the level of calcium in the blood gradually decreases. Often used for cutaneous forms of the disease and neurosarcoidosis.
Pentoxifylline and alpha-tocopherol Dosages and regimen do not differ from those for monotherapy. Duration of treatment – ​​24 – 40 weeks. Combined therapeutic effect of these drugs.

In addition to these standard regimens, non-steroidal anti-inflammatory drugs have been used in the treatment of sarcoidosis ( diclofenac, meloxicam, etc.). Their effectiveness turned out to be significantly lower than that of GCS. However, in the early stages of the disease and when GCS doses are reduced, non-steroidal anti-inflammatory drugs are recommended in a number of countries.

Local drug treatment

Local drug treatment is used mainly for cutaneous and ocular forms of sarcoidosis. In this case, special attention is paid to eye damage, since it differs from the general treatment strategy and poses a serious threat of complete and irreversible blindness.

To begin treatment for uveitis in sarcoidosis, accurate confirmation of the diagnosis is required. It is obtained by biopsy of nodules in the eye and detection of sarcoid granulomas in other organs. While the diagnosis is confirmed, it is recommended that the patient be admitted to the hospital. Inpatient treatment It is also indicated for patients with severe inflammation, who may develop serious complications that threaten vision loss.

The selection of a specific treatment regimen for uveitis in sarcoidosis is made by an ophthalmologist. It depends on the localization of the inflammatory process ( anterior, posterior or generalized uveitis) and its intensity.

The following drugs are used in the treatment of uveitis in sarcoidosis:

  • With anterior uveitis - cyclopentolate, dexamethasone, phenylephrine ( in combination with dexamethasone for severe inflammation). The drugs are prescribed in the form of eye drops.
  • For posterior uveitis - dexamethasone, methylprednisolone as an intravenous dropper, as well as retrobulbar dexamethasone ( injection under the eye with an extended needle to deliver the drug to the posterior pole of the eye).
  • For generalized uveitis - a combination of the above drugs in a higher dose.
This scheme is called pulse therapy because it is aimed at quick fix severe inflammation high doses of drugs. After the end of pulse therapy, which lasts 10–15 days, the same drugs are prescribed in the form of drops. They are used for 2 - 3 months to maintain normal condition. The main criterion for the effectiveness of treatment is the disappearance of symptoms of inflammation. After diagnosis of sarcoidosis, patients with signs of eye damage should regularly visit an ophthalmologist for preventive check-ups for the rest of their lives.

Treatment of the cutaneous form of sarcoidosis is, in fact, not very different from systemic treatment. The same drugs can be used in parallel in the form of ointments or creams, which will enhance the local therapeutic effect. Given the side effects of treatment, some doctors do not recommend intensive treatment of skin manifestations of sarcoidosis unless they are located on the face or neck. The fact is that the patients' problems in these cases are a cosmetic defect and do not pose a serious danger to their life or health.

Surgical treatment

Surgical treatment It is used extremely rarely in sarcoidosis. Removing enlarged lymph nodes in the chest is impractical, as it involves a large-scale operation, while sarcoid granulomas will form again. Surgery is possible only in extreme cases to save the patient’s life in the terminal stages of the pathological process. Also the need for surgical intervention may occur when pulmonary and extrapulmonary complications of sarcoidosis occur.

Patients with sarcoidosis may undergo the following types of surgical interventions:

  • Elimination of defect in case of lung collapse. Due to damage to the lung tissue, pathological communication may occur between the air ducts and the pleural cavity. Due to the difference in pressure, this will cause the lung to collapse and cause acute respiratory failure.
  • Lung transplant. This operation is performed extremely rarely due to the high cost and complexity of the procedure. The indication for it is widespread fibrosis of the lung tissue. Due to the overgrowth of bronchioles, the vital capacity of the lungs is critically reduced and respiratory failure occurs. After a lung transplant, more than half of patients live at least 5 years. However, there is a risk that the disease will develop again in the transplanted organ.
  • Stopping bleeding in the gastrointestinal tract. Usually the operation is performed laparoscopically ( without wide tissue dissection). IN abdominal cavity a special camera and manipulators are introduced to stop the bleeding without serious risk to the patient’s health.
  • Splenectomy. It is practiced with a significant increase in it, if it has been proven that it contains sarcoid granulomas.

Irradiation

According to a number of studies conducted in the United States, sarcoidosis that is resistant to treatment with corticosteroids can be treated with radiation. In this case, only the affected area of ​​the body is irradiated ( for example, only rib cage ). The best results were observed in patients with neurosarcoidosis. After 3–5 procedures, a stable remission was established with the disappearance of most acute symptoms.

Diet

There is no specific diet for patients with sarcoidosis. According to some studies, it has proven itself best therapeutic fasting. In almost 75% of cases, it inhibits the development of the pathological process and leads to a pronounced improvement in the condition. However, it is not advisable to practice regular fasting on your own. This treatment method is used mainly in a hospital setting under the supervision of a physician. Ordinary fasting at home, which some patients voluntarily try to practice, not only does not provide a therapeutic effect, but can also sharply worsen the course of the disease.

Prevention of disease complications

Prevention of complications of the disease involves limiting contact with factors that could cause sarcoidosis. First of all, we are talking about environmental factors that can enter the body with inhaled air. Patients are advised to regularly ventilate the apartment and do wet cleaning to avoid air dust and mold formation. In addition, it is recommended to avoid prolonged sunbathing and stress, as they lead to impairment metabolic processes in the body and intensification of the growth of granulomas.

Preventive measures also include avoiding hypothermia, as this can contribute to the addition of a bacterial infection. This is due to deterioration of lung ventilation and weakening of the immune system in general. If it is already present in the body chronic infection, then once sarcoidosis is confirmed, you should definitely visit your doctor to find out how you can most effectively control the infection.

In general, the prognosis for sarcoidosis is conditionally favorable. Death from complications or irreversible changes in organs is recorded only in 3–5% of patients ( with neurosarcoidosis in approximately 10–12%). In most cases ( 60 – 70% ) it is possible to achieve stable remission of the disease during treatment or spontaneously.

The following conditions are considered indicators of an unfavorable prognosis with severe consequences:

  • the patient's African-American origin;
  • unfavorable environmental conditions;
  • long period of temperature rise ( more than a month) at the beginning of the disease;
  • damage to several organs and systems simultaneously ( generalized form);
  • relapse ( return of acute symptoms) after completing the course of treatment with GCS.
Regardless of the presence or absence of these signs, people who have been diagnosed with sarcoidosis at least once in their lives should visit their doctor at least once a year.

Complications and consequences of sarcoidosis

As stated above, sarcoidosis itself rarely causes death or serious problems with health. The main danger with this disease lies in the possibility of developing serious complications diseases. They are divided into pulmonary, which is the most common, and extrapulmonary, which is usually more serious than pulmonary.

The most common complications and consequences of sarcoidosis are:

  • lung collapse;
  • bleeding;
  • frequent pneumonia;
  • kidney stones;
  • violations heart rate;
  • pulmonary fibrosis;
  • blindness and irreversible vision loss;
  • psychological problems.

Lung collapse

Lung collapse occurs due to the collapse of lung tissue. Most often this occurs if an acute inflammatory process or the growth of granulomas has led to rupture of the pleura. Then the pressure in the pleural cavity begins to equalize with atmospheric pressure. The lung, due to its structure, has its own elasticity. At equal pressure inside and outside it quickly begins to shrink. When compressed, not only does gas exchange not occur, but they are also compressed blood vessels, which leads to dysfunction of the heart. Without immediate medical attention, a patient with a collapsed lung may quickly die due to acute respiratory failure. Treatment includes surgical closure of the lung defect and removal of excess air from the pleural cavity to allow recovery normal pressure. With timely intervention serious consequences after the collapse of the lung is not observed.

Bleeding

Bleeding in sarcoidosis occurs due to direct damage to blood vessels by inflammatory changes. In the pulmonary form, this complication rarely develops. Vascular damage is more common when granulomas are localized on various levels V digestive system. Repeated nosebleeds are also often observed with sarcoidosis of the ENT organs.

Usually bleeding stops spontaneously and does not require serious measures to stop it. The situation is somewhat more severe in patients with liver sarcoidosis. The fact is that the liver produces a large number of coagulation factors ( substances necessary to stop bleeding). With severe impairment of liver function, the amount of coagulation factors in the blood decreases, which makes any bleeding longer and more abundant.

Frequent pneumonia

Frequent recurrent pneumonia is a common complication in patients at stages 2–3 of sarcoidosis. Due to poor ventilation and local disturbances, any infection can cause pneumonia. This happens especially often after starting a course of treatment with corticosteroids ( prednisolone, methylprednisolone, dexamethasone, etc.). This category of drugs weakens the immune system, increasing the risk of developing a bacterial infection.

Kidney stones

As noted above, kidney stones or sand are found in a significant proportion of patients with sarcoidosis. This complication The disease develops due to elevated levels of calcium in the blood. Calcium enters the kidneys with the blood during filtration. In the renal pelvis it binds with other trace elements, forming insoluble salts. Patients may, in the middle of treatment for sarcoidosis, begin to complain of sharp, excruciating pain in the lower back in the kidney area. This forces us to interrupt the course of treatment for sarcoidosis and pay attention to treatment renal colic and stone removal.

Heart rhythm disturbances

Heart rhythm disturbances, as mentioned above, can be a consequence of both cardiac and pulmonary form sarcoidosis. At first they are a symptom of the disease, but in severe cases they can be regarded as a complication. The point is that persistent impairment rhythm leads to a deterioration in the supply of oxygen to the brain. In addition to repeated fainting, this is fraught with irreversible damage due to the death of nerve fibers. Resuscitation measures may often be necessary to restore normal heart rhythm.

Pulmonary fibrosis

Pulmonary fibrosis is the final stage of the pulmonary form of sarcoidosis. This process begins at stages 2–3 of the disease, when symptoms are just beginning to appear. Gradually, due to prolonged inflammation and compression of tissues by enlarged lymph nodes, normal lung tissue replaced by connective tissue cells. These cells are unable to exchange gases, making it increasingly difficult for the patient to breathe. Effective method There is virtually no treatment for pulmonary fibrosis. The only solution is an organ transplant.

Blindness and irreversible vision loss

Blindness and irreversible vision loss can occur with delayed treatment eye-shaped sarcoidosis. The inflammatory process in the eye membranes leads to the launch of a number of pathological mechanisms (direct tissue damage, increased intraocular pressure, edema optic nerve ). Many changes at eye level are irreversible. This is fraught with loss or sharp deterioration of vision, which practically guarantees disability. That is why patients with sarcoidosis at the slightest sign of eye damage need to urgently seek medical attention. specialized assistance see an ophthalmologist. Timely assistance with high probability will stop the inflammatory process and preserve vision.

Psychological problems

Psychological problems in patients with sarcoidosis are perhaps the least life-threatening but most common consequences of the disease. First of all, this applies to patients in the first stages who did not receive a specific course of treatment due to the possibility of spontaneous remission of the disease. Such patients are characterized by fear of death, depression, deep depression, and insomnia. These symptoms persisted even in many of those patients whose sarcoidosis did not progress.

Such problems are purely psychological in nature. Not the least role is played by the unclear origin of the disease and the lack of specific highly effective treatment. To combat such problems, doctors must be very careful in formulating a diagnosis and prognosis regarding the course of the disease. Patients are advised to consult a psychologist for specialized help.

Sarcoidosis (Besnier-Beck-Schaumann disease) – systemic chronic autoimmune disease unknown etiology, which affects internal organs (sarcoidosis of the lungs, damage to the eyes, digestive organs, damage to nervous system(neurosarcoidosis), renal sarcoidosis, musculoskeletal system lesions, sarcoidosis oral cavity and ENT organs) and skin. If the first place among all these diseases is taken by pulmonary sarcoidosis, then the second place belongs to cutaneous sarcoidosis.

Sarcoidosis of the skin - what is it?

The formation of granulomas is the main symptom of the disease. These are small limited foci of inflammation, with the form of dense nodules of various sizes and colors. Their number can vary from tens to several thousand.

The disease largely affects young and middle-aged people. Slightly more common in older women. In children, cases of skin sarcoidosis are very rare and are hereditary or isolated in nature.

Characteristic properties of the disease: multisystemic, the presence of inflammation, benign. This disease is not infectious and cannot be transmitted to others.

Skin lesions occur in only 25% of patients, and this is in in some cases the only manifestation of the disease.

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Causes of skin sarcoidosis

Although the first case of cutaneous sarcoidosis was described in the UK by dermatologist Jonathan Hutchinson back in 1877, the etymology of the origin of the disease has not been established to date.

Sarcoid - common name lesions in skin sarcoidosis in the form of tubercles (actually in the skin) or nodes (in the subcutaneous tissue).

The disease has different types:

  1. Small nodular disseminated or papular disseminated - distinctive features are lesions of the skin with multiple dense papules. Their shape is spherical or oval, their size is small - 0.5 cm. They are painless on palpation. During diascopy, they appear as yellow-golden spots or dots.

In the final stage of development of the disease, the nodules become flatter, flake, pigmented or depigmented.

Locations - mainly located on the face, shoulder blades, décolleté and elbow bends.

  1. Large nodular - the distinctive feature is the appearance of a separate node. The size is large - about 2 cm. The surface is rough, red or white. Over time, the nodes disappear and pigmented spots remain on the surface of the affected skin area.

Locations: face and neck area, groin, rarely – on the arms.

Other forms of the disease

There are other types of cutaneous sarcoidosis. Among them are:


In general, the disease is periodic.

Symptoms of cutaneous sarcoidosis

Classic symptoms of the disease manifest themselves in the form of damage to the surface of the skin:

  • Plaques;
  • Knots;
  • Scars;
  • Ulcers;
  • Maculopopular rash;
  • Psoriasis-like changes;
  • Alopecia (baldness);
  • Damage to the nail plates.

With sarcoidosis of the skin, deformation of the skin occurs, which makes the skin less attractive. As a result, the patient’s mental health is depressed. The patient experiences depression and, as a result, a disorder of the nervous system.

Diagnostics

Making an accurate diagnosis in the early stages of the development of cutaneous sarcoidosis is rare, since this type of skin lesion very skillfully disguises itself as the most common diseases of the skin and soft tissues. Therefore it is necessary differential diagnosis with diseases of a similar clinic, such as:

  • Psoriasis;
  • Ichthyosis;
  • Necrobiosis lipoidica;
  • Dermatomycosis;
  • Cutaneous tuberculosis;
  • Discoid lupus erythematosus;
  • Cutaneous vasculitis;
  • Red lichen planus;
  • B-cell lymphoma (mycosis fungoides).
  • Leprosy.

Diagnosis of this disease also includes:

Which doctor treats sarcoidosis of the skin?

The main specialist dealing with the problems of skin lesions by sarcoidosis is a dermatologist. Since this disease can affect not only the skin, but also other organs and systems of the human body, monitoring must be prescribed by other specialists:

  • Infectious disease specialist;
  • Pulmonologist;
  • Rheumatologist;
  • Ophthalmologist.

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* Having received data about the patient’s disease, the clinic representative will be able to calculate the exact price for treatment.

Treatment of the disease

When treating skin sarcoidosis, a variety of therapy methods are used - medication, laser therapy, cryotherapy, surgery, ultraviolet radiation, electrophoresis, Bucca rays.

Drug therapy

In order to alleviate the symptoms of damage to skin sarcoidosis, a variety of creams and ointments with anti-inflammatory effects, which contain glucocorticoids, are usually prescribed.

For example:

It is also possible to inject glucocorticoids directly into the plaques.

Stellanin ointment has regenerating properties. It is prescribed to prevent the occurrence of scars and accelerate the healing of elements skin rash and creating obstacles to their secondary infection.

It is also possible to assign the following drugs, which have proven their effectiveness in some studies:

  • Doxycycline;
  • Melatonin;
  • Tetracycline;
  • Pentoxifylline;
  • Isotretinoin;
  • Psoralen in combination with ultraviolet irradiation.

Important! Never self-medicate. Due to the fact that all of the listed drugs have different pharmacological and side effects, choosing the appropriate medicinal product stands behind the doctor.

A depressive state is the reason for the prescription of sedatives and, in extreme cases, antidepressants to patients whose disease becomes chronic and tends to develop disfiguring cosmetic defects.

In cases of advanced disease, in which the symptoms of the disease progress, the patient is indicated for treatment in a hospital. For a period of one to two months. Outpatient therapy is then recommended, which in turn lasts several more months.

It is important to remember that often manifestations of cutaneous sarcoidosis can disappear, just as they can appear - for no reason.

Surgical therapy

Small or more disfiguring lesions of the skin are removed using a scalpel, diathermocoagulation or laser therapy. However, this therapy is rarely used, as the risk of scarring and relapse is increased.

Treatment with folk remedies

Treatment for skin lesions with sarcoidosis folk remedies ineffective, but it is used as an addition to drug therapy. Let's look at a few recipes:

Propolis tincture

You can buy it at the pharmacy or prepare it yourself. Take 100 gr. propolis, place in a bottle of vodka and infuse for one month. Take 20-30 drops before breakfast, after dissolving in milk or water. Course - 28 days.

Rhodiola rosea tincture


Take 15 drops, diluted in water, in the morning before breakfast and in the afternoon before lunch. Course – 2 times for 25 days, with a break of two weeks.

Decoction of grape cuttings

Take 300 gr. grape cuttings, place in an enamel bowl, add half a liter of water, cook for 20 minutes. After the broth has cooled, be sure to filter it. We drink 150-200 ml with honey instead of tea every day.

Herbal tea

Mix equal parts of oregano stems, sage, marshmallow root, plantain and knotweed leaves, and marigold flowers. Then pour boiling water over the herbal mixture at the rate of 1 tbsp. l.-1.5 glasses of water. Leave in a dark place for 1 hour, after wrapping it in a towel. Take two tablespoons 4 times a day. Course – 4 times for 28 days, with a break of one week.

Eucalyptus tea

Brew 50 g. eucalyptus leaves half a liter of boiling water. We insist during the day. We drink 100 ml of tea with honey in the evening after dinner.

Decoctions or tinctures can also be used externally in the form of compresses or lotions. They also make baths with herbs that have high anti-inflammatory properties: chamomile, string, sage, calendula.

Another method of external exposure provides slight relief for skin affected by sarcoidosis. This is a mixture of grated onion and sunflower oil. It is applied to the affected areas and secured with a bandage.

Preventive measures

As such, there is no prevention against cutaneous sarcoidosis. But there are certain recommendations that can significantly reduce the possibility of the occurrence of this disease. Among them:

  • The need to undergo a full medical examination at the clinic;
  • Mandatory adherence to a healthy and active lifestyle;
  • Exceptions, if possible, are prolonged exposure to the sun, in a solarium;
  • Increasing immunity, including recovery from diseases that lower it;
  • Following a loose balanced diet;
  • Avoid contact with substances that cause allergies and various skin irritations.

Diet

  • Food should be taken 5-6 times a day in small portions;
  • Eat foods high in Omega-3 fatty acids (fish oil, flax seeds). They help stimulate the production of hormones aimed at reducing the inflammatory process;
  • Increase the diet of fruits and vegetables with a significant content of vitamin C;
  • It is necessary to reduce to a minimum the number of products high content calcium;
  • Avoid carbonated drinks and sweet flour products;
  • It is advisable to reduce the amount of sugar consumed;
  • Exclude fried, salty, canned foods, as well as hot sauces and seasonings from the menu.

Observation

Important! After treatment, monitoring of the condition of the skin is necessary, due to the fact that in 40% of cases the course of the disease acute form relapse occurs. This is the main task of both the doctor and the patient.

After completion of treatment, all patients must register with a dermatologist at a skin clinic for at least three years. For minor skin lesions, patients need to be examined 2 times a year for two years. If lung damage was recorded during the course of the disease, then the frequency of doctor visits increases.

During repeated visits to the doctor, the skin is examined to identify new rashes. Chest x-rays, CT scans, and function assessments may also be ordered. external respiration to avoid recurrent damage. And in addition, they may prescribe a biochemical blood test to determine the amount of vitamin D and calcium.

Due to the increased risk of developing squamous cell skin cancer, patients with cutaneous sarcoidosis are advised to undergo regular monitoring of skin and blood tests.

In addition to abnormal phenomena in the lungs or other tissues internal organs which causes sarcoidosis, every 4 patients At the same time, the skin is affected.

The main complexity of the disease is its multisystem nature and the inexplicability of its underlying causes.

Granulomas from massive accumulations of leukocytes and macrophages affect large areas of the skin in the form of all kinds of spots, plaques and nodes.

Etiology of cutaneous sarcoidosis

There are still no officially recognized medical explanations for this pathology.

New assumptions appear periodically, then they are refuted. Therefore, the following can be said about the causes of the development of sarcoidosis in general:

  • There is a certain long-lasting effect trigger, which ultimately triggers an anomalous process.
  • Traceable genetic predisposition.
  • A functional failure occurs endogenous interferons.
  • The disease is not infectious; therefore, it is completely safe for others.

Reference! Age of most patients does not exceed 40 years.

Types of skin manifestations: symptoms and photos

There are the following types of cutaneous sarcoidosis.

Large nodular

This type of skin sarcoidosis occurs mainly on the face and neck and consists of individual red or brown nodules, each size up to two centimeters in diameter. Slightly less commonly, sarcoids are found on the arms, legs and groin area. On the surface of each sarcoid, either white milia or diffuse red plaques may form in the form of an expanded set small vessels.

Photo 1. This is what the large-nodular form of cutaneous sarcoidosis looks like: red nodules are visible on the arm.

The behavior of such sarcoids is always difficult to predict: they either remain on the skin for several years in an unchanged state, or disappear on their own without any targeted treatment. In this case, the surface of the skin in their place remains permanently pigmented. At the stages of sudden exacerbations of the disease, small-nodular sarcoids often develop in this place.

Small nodular

The most common form of the disease. It consists of numerous clusters of hard brick-red granulomas with a purple tint, each of which no more than 6 mm. Sarcoids affect the skin of the face, the folds of the arms, and the upper torso. The surface of sarcoids often peels off. They are distinguished by clear boundaries and clearly rise above the skin.

Photo 2. Small nodular form of sarcoidosis: red granulomas with a diameter of no more than 6 mm affect the skin of the face.

Around such clusters of sarcoids there are observed age spots, and in some cases even selective necrosis occurs. Rashes always appear spontaneously, relapses occur at different intervals: from a couple of months to several years.

Besnier-Tenneson's lupus pernio: what is it?

One of the most severe forms sarcoidosis of the skin. Red plaques with a purple tint localized on the face, covering the cheeks, forehead, nose, chin. The ears are also often affected. At low temperatures, the bluish tint appears to the maximum, which creates an additional cosmetic defect. Lesions can ulcerate unpredictably and leave behind scarring.

There are cases when plaques localized on the wings of the nose spread to nasal septum what provokes systematic bleeding and regular formation of crusts.

Patients with lupus pernio are characterized by primary sarcoidosis lesions of the lymph nodes, lungs, bone tissue and joints.

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Darrieus-Roussy nodular sarcoids

Darier-Rousse nodular sarcoids are quite rare. Nodular sarcoids appear as large, dense nodules up to 3 cm in diameter. Sarcoids are often found on the sides, thighs and abdomen. Often, several dozen sarcoids accumulate in large foci, covering an area on the skin up to 20 cm.

Photo 3. Nodular Darrieus-Roussy sarcoids: nodes up to 3 cm in diameter and their clusters in the form of foci up to 20 cm.

The surface of the overlying skin is dull pink with bluish tint and may be soldered to the nodes. In this case appearance the affected area resembles orange peel. Granulomas do not ulcerate and most often do not cause painful discomfort.

Erythema nodosum

Painful nodes on palpation in size up to 5 cm. Sarcoids are typically located on the front of the legs, but also occur on the feet and forearms. Sarcoids do not itch, but cause spontaneous painful sensations.

Erythema nodosum can be quickly recognized by low-grade fever and muted pain in the joints. Blood test shows elevated leukocytes and ESR.

Within 4-6 weeks Sarcoids usually disappear, leaving hyperpigmentation and flaking of the skin. As a rule, they do not relapse.

Erythema nodosum varies depending on the course of the disease. V three forms: acute, migratory and chronic.

Broca-Pautrier angiolupoid on the face

Red bean-shaped plaques with a purple tint, which are characterized by development in single option. Sarcoids in diameter do not exceed 3 cm and are almost always formed only on the face: on the forehead, nose and cheeks. In rare cases, this form of cutaneous sarcoidosis can be found on another part of the body.

The granuloma has a soft elastic consistency and is covered with telangiectasia. Sarcoid does not cause any particular discomfort to the patient.

Diffuse infiltrative sarcoidosis

A very rare form of cutaneous sarcoidosis.

Sarcoids are large bluish-brown dense plaques with blurred borders measuring up to 15 cm.

Sarcoids form on the nose, cheeks, and on the back of the hand. Extensive infiltrates tend to merge.

In this case erythroderma cannot be excluded, which is fraught unfavorable prognosis.

Diagnosis before skin lesions

In the initial stage, diagnosing cutaneous sarcoidosis is always difficult. Its earliest manifestations can easily be mistaken for leprosy, ichthyosis, lichen planus, psoriasis, lymphocytoma, dermatomycosis, cutaneous tuberculosis and even syphilis. Therefore, skin sarcoidosis can be confirmed solely on the basis of the following indicators:


Treatment

How successful the restoration of the affected skin will be will directly depend on the positive progress in the treatment of concomitant sarcoidosis of the lungs or bones. The duration of treatment for cutaneous sarcoidosis is on average 5-6 months.

Treatment of skin sarcoidosis in most cases is indicated with medication, but minimally invasive or surgical techniques, if an objective need arises.

Treatment of the affected areas is carried out locally - with lotions and ointments with corticosteroids containing: Laticort, Afloderm, Hydrocortisone, Triacort, Stellanin. The drugs are applied daily at regular intervals up to 4 times a day. Injections into granuloma clusters show good effectiveness Triamcinolone with 1% novocaine once every 10-14 days.

Skin lesions are often also serious cosmetic defect, especially for women who suffer from sarcoidosis more often.

In such cases it will be relevant daily systemic therapy with Prednisone or Prednisone in daily dosage up to 40 mg.

Through a few days the dose must be gradually reduced and stopped by 10 mg per day as mandatory support. But stopping the drug almost always provokes relapses. in 4-5 months.

Helps effectively fight lupus pernio Chloroquine. The initial daily dose of the drug should not exceed 250 mg for the first 3 months. In the future for the next six months reception increases up to 2 times a day 250 mg. It is highly not recommended to take Chloroquine for longer than this period in order to prevent irreversible retinopathy.

In combination with corticosteroids, it is advisable to take such cytostatics as Prospidin, Azathioprine or Methotrexate. During the acute course of the disease, spontaneous cures also occur periodically.