Cutaneous Sarcoidosis- A not so Rare Entity in Pakistan

Abstract

Objective: To study the demographic characteristics, clinicopathological features and radiological stage of cutaneous sarcoidosis in a public sector tertiary care hospital of the largest metropolitan city of Pakistan.

Methods: A case series was conducted from August 2014 to July 2017 at the Dermatology department of Civil Hospital Karachi. Case records of cutaneous sarcoidosis patients with a histopathological diagnosis of noncaseating sarcoidal granuloma on skin biopsy were reviewed. Diagnosis was done based on clinical manifestations, radiologic examinations and pathologic data.

Results: Mean age at the time of diagnosis was 35.8 years, while the mean duration of disease was 31.6 months. Plaques were found in five patients (50%), one of whom had coexistent plaques and nodules. Three patients (30%) displayed subcutaneous lesions, whereas two patients (20%) had maculopapules. Extracutaneous involvement occurred in six patients (60%), affecting mainly lungs and lymph nodes. Skin biopsy revealed typical sarcoid non-caseating granulomas in nine cases (90%). Radiological evaluation revealed Stage 0 in six patients (60%), Stage 1 and 3 in one patient (10%), while two patients (20%) showed Stage 2 involvement. The mainstay of treatment was topical or systemic corticosteroids to which a good response was achieved.

Conclusion: Our study concurred with the literature in that sarcoid plaques are the most common lesions while the involvement of the lungs and lymph nodes are the commonest extracutaneous features. Moreover, since cutaneous sarcoidosis leads to a diverse range of presentation, diagnosis in countries like Pakistan, where tuberculosis is endemic can be overlooked. Therefore, further studies are needed to overcome this diagnostic dilemma.