Recalcitrant cutaneous sarcoidosis: an evidence-based sequential approach

Area of Science:

• Dermatology
• Immunology
• Rheumatology

Background:

• Cutaneous sarcoidosis presents more severely in individuals with black skin.
• A subset of these patients exhibit disease recalcitrant to standard therapies, posing a significant clinical challenge.

Purpose of the Study:

• To characterize the clinical presentation of recalcitrant cutaneous sarcoidosis (RCS).
• To evaluate the efficacy of sequential therapeutic interventions for RCS.
• To propose a treatment algorithm for managing challenging cases of cutaneous sarcoidosis.

Main Methods:

• Retrospective analysis of patients diagnosed with recalcitrant cutaneous sarcoidosis.
• Data collection included demographics, clinical manifestations, histopathology, and treatment responses.
• Evaluation of sequential therapy outcomes, including relapse rates.

Main Results:

• Six patients with recalcitrant cutaneous sarcoidosis (all with black skin) were identified, with a mean lesion duration of 11.3 years.
• Various skin lesions were observed, alongside extracutaneous involvement in four patients (pulmonary, dactylitis, hepatosplenomegaly).
• No patient responded to prednisone alone; however, all achieved remission with sequential therapy using second-line agents like chloroquine and methotrexate, with no relapses.

Conclusions:

• Sequential therapy is a viable strategy for managing aggressive cutaneous sarcoidosis.
• This approach minimizes exposure to toxic systemic drugs.
• Effective control of recalcitrant cutaneous sarcoidosis lesions can be achieved, preventing relapses.