Sarcoidosis of the pinnas in a 17-year-old

A 17-year-old girl presented with persistent swelling and erythema of the midportion of the helix of the pinnas, with no associated history of pain, fever, or hearing loss. The area was erythematous, with crusting and a minimal amount of pus. Her otologic examination was otherwise normal. A culture grew Staphylococcus (nonaureus). Over a 9-month period, she had flair-ups of the lesions with minimal response to topical and oral antibiotics. A dermatology consultation was obtained, and she was started on topical steroids, with no clinical improvement. She then developed raised erythematous lesions. Blood work showed no obvious immune disorder or evidence of an infectious process. A full-thickness skin biopsy was then taken, and pathologic examination found noncaseating granulomatous dermatitis; the histopathologic diagnosis was sarcoidosis. The patient was then referred to rheumatology for further evaluation and treatment. Although sarcoidosis is rare in the pediatric population, skin lesions that do not respond to medical therapy should be considered for biopsy.