Cutaneous sarcoidal granulomas and the development of systemic sarcoidosis

Studies of patients with systemic sarcoidosis have indicated that those patients with cutaneous lesions have a poorer prognosis with a greater incidence of symptomatic pulmonary and ocular sarcoidosis. We examined 18 patients who had biopsy-proved cutaneous sarcoidosis for evidence of systemic involvement. Of the 13 patients who had no history of previously documented sarcoidosis, six had no evidence of systemic disease on history and physical examination, chest roentgenogram, pulmonary function testing, ocular examination, skin testing, and baseline laboratory testing. The seven remaining patients had evidence of sarcoidosis in another organ system, but six of the seven were essentially asymptomatic and required no therapy. The poorer prognosis associated with cutaneous sarcoidal granulomas drawn from populations with proved systemic sarcoidosis does not seem to apply to generally healthy outpatients with skin lesions as the initial manifestation of their disease.