Sarcoidosis

What is sarcoidosis?

Sarcoidosis is a medical condition characterized by the formation of granulomas, which are tiny clusters of inflammatory cells. While these granulomas can manifest in various parts of the body, including the skin, they predominantly affect the lungs and lymph nodes. However, organs like the heart or brain are not exempt from the disease's reach. Certain demographics, including women and individuals of African American descent, are more prone to sarcoidosis. In some cases, sarcoidosis can resolve independently, but in others, it lingers, presenting a diverse array of symptoms.

What causes sarcoidosis?

The exact origin of sarcoidosis remains a mystery. Current understanding suggests that genetic predispositions make some individuals more vulnerable, prompting an abnormal immune response when exposed to certain environmental factors or infections. Risk elements encompass:

• Ethnic backgrounds such as African American, Scandinavian, German, Irish, or Puerto Rican

• Age brackets of 20 to 40

• Female gender

• Exposure to specific pathogens like mycobacteria, fungi, Borrelia, and Rickettsia bacteria

• Having autoimmune conditions

• Administration of certain biologic drugs

What are the symptoms of sarcoidosis?

Sarcoidosis can mimic several other ailments, earning its title as one of the diseases called "the great imitator." The gamut of its symptoms is vast, with some general manifestations like weight loss, fever, fatigue, and malaise.

Skin-specific symptoms involve:

• Small bumps, typically 1-2 cm, predominantly on the shins

• Nummular eczema

• Subcutaneous hard deposits

• Itchiness

• Large, bluish-red or purple bumps, and flattened patches mainly on the cheeks, ears, fingers, and toes, referred to as lupus pernio

• Reddish-brown, thickened, round skin patches

• Augmentation of pre-existing scars

Non-skin-specific symptoms feature:

• Elevated calcium levels in the blood

• Respiratory issues such as shortness of breath or persistent cough

• Hoarseness of voice

• Vision disturbances, including dry eyes or blurriness

• Liver enlargement

• Swollen ankles

• Discomfort in the chest region

• Arrhythmias or irregular heartbeats

• Neurological symptoms like headaches or confusion

How do I treat sarcoidosis?

The therapeutic approach for sarcoidosis hinges on its severity, the organs affected, and the specific symptoms exhibited. Some patients might not necessitate any explicit treatment. For those with skin-limited sarcoidosis, localized treatments might suffice, but often multidisciplinary consultation becomes crucial. Potential treatments include:

• Topical or intralesional steroids, especially when the disease is skin-centric

• Systemic steroids, such as prednisone

• Immune-modifying drugs like methotrexate, azathioprine, and hydroxychloroquine

• Tetracycline class antibiotics, e.g., doxycycline or minocycline

• Biologic agents targeting TNF alpha or IL-17 pathways

• Laser treatments for cutaneous manifestations