|LETTER TO EDITOR
|Year : 2019 | Volume
| Issue : 1 | Page : 104-105
Rohan M Patil, Vidyadhar R Sardesai, Trupti D Agarwal
Department of Dermatology, Venereology and Leprosy, Bharati Vidyapeeth (Deemed to be University) Medical College and Hospital, Pune, Maharashtra, India
|Date of Web Publication||14-Feb-2019|
Vidyadhar R Sardesai
102 Alliance Nakshatra, 48 Tulshibagwale Colony, Sahakar Nagar No. 2, Pune - 411 009, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Patil RM, Sardesai VR, Agarwal TD. Micropapular sarcoidosis. Clin Dermatol Rev 2019;3:104-5
Sarcoidosis is a granulomatous disorder. It involves skin and systemic organs having unknown cause. Hereby, we describe a rare case of micropapular sarcoidosis on the face with no systemic involvement.
A 25-year-old male presented to the outpatient department of our hospital with chief complaints of asymptomatic progressive skin-colored papules on the face. The papular lesions started on the chin and were present for 2 months. Papules gradually increased in size and number involving the entire face. The lesions were not associated with cough, fever, weight loss, or any other systemic involvement. The patient had no history of any major illness and no significant family history. General and systemic examination was within normal limits.
Cutaneous examination revealed multiple close-set 1–4 mm skin colored, nontender, nonscaly, grouped papules on the chin [Figure 1], upper lip, nose, cheeks, and forehead. Palms, soles, hair, nail, and mucosal areas were not involved. No Koerner's phenomenon was observed. Differential diagnosis considered were lichen nitidus, acne, Histoid Hansens, cutaneous tuberculosis, micropapular sarcoidosis, adenoma sebaceum, papular syphilide, and trichoepithelioma.
Laboratory investigations such as hemogram, serum calcium, liver, and renal function tests were within normal limits. Serum angiotensin-converting enzyme titer was 70 U/L. Slit-skin smear for acid-fast bacilli was negative; Mantoux test was negative and venereal disease research laboratory test was nonreactive. X-ray chest (postero-anterior view) and ultrasound abdomen – pelvis showed no abnormality.
Skin biopsy from the face showed a sarcoidal granulomas (noncaseating granulomas) that impinged onto the overlying epidermis and small perifollicular noncaseating granulomas in the mid-dermis [Figure 2]. The biopsy findings were consistent with micropapular sarcoidosis.
|Figure 2: Histopathological examination showing sarcoidal granulomas (Haemetoxylin and Eosin stain,10 X magnification)|
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The patient was started with methylprednisolone 8 mg orally and topical mometasone furoate 0.1% cream for 15 days and the lesions resolved. Unfortunately, the patient was lost for further follow-up.
Sarcoidosis is a multisystem disease which commonly affects the lungs, lymph nodes, eyes, bones, and skin. Sarcoidosis is more common in females and in the age group of around 40 years. Skin involvement is seen in about 20%–35% of cases with systemic disease and approximately 10% of patients present as cutaneous lesions. Sarcoid lesions generally have no symptoms but in about 10%–15% may itch.
Morphological patterns of sarcoidosis are papular, micropapular, plaques, subcutaneous nodules, lupus pernio, scar, erythema nodosum, ulcerative, follicular, verrucous, and many other patterns. Sarcoidosis on the face mimics a lot of conditions such as lichen nitidus, acne, Histoid Hansens, cutaneous tuberculosis, adenoma sebaceum, papular syphilide, and trichoepithelioma. Papular sarcoidosis can have a variable presentation as reddish, reddish-brown, violaceous, translucent, or hyperpigmented papules.
The most common presenting and characteristic feature of cutaneous sarcoidosis is lupus pernio. It presents as a chronic bluish plaque mostly on the nose and at times involving the cheeks, nasal septum, and mucosa.
Histopathology of sarcoidosis shows superficial dermal noncaseating epithelioid granulomas.
Out of the various therapeutic options available for the treatment of sarcoidosis, systemic glucocorticoids are very beneficial. For disease limited to the skin, intralesional therapy with triamcinolone acetonide has proved beneficial.
Micropapular sarcoidosis is quite rare. Very few cases have been reported, especially in Indians. Therefore, we present a rare case of micropapular sarcoid in a 25-year-old Indian male.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]