Clinicopathologic features of ulcerative-atrophic sarcoidosis

Simon S. Yoo, Daniel Mimouni, Olga V. Nikolskaia, David J. Kouba, Daniel N. Sauder, Carlos H. Nousari*

*Corresponding author for this work

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background. Sarcoidosis is a chronic granulomatous disease of unknown etiology. Cutaneous disease is common and includes two clinicopathologic categories: granulomatous infiltration or a reactive phenomenon. In the granulomatous infiltrative group, clinical manifestations can be variable. Ulcers in sarcoidosis are uncommonly recognized and have been categorized previously under the rubric of atrophic, necrobiosis-like, or ulcerative sarcoidosis. Patients and methods. We evaluated retrospectively sarcoidosis patients presenting to the Johns Hopkins Department of Dermatology between June 1989 and May 2002. Multiple skin biopsies were performed for histopathologic evaluation. Investigation for extracutaneous manifestations, including routine serologic assays, chest radiography, pulmonary function tests, electrocardiogram, and angiotensin-converting enzyme level, and referral for ophthalmologic examination were performed in all patients. Results. Of 147 consecutive patients presenting with cutaneous sarcoidosis, seven demonstrated ulcerative-atrophic sarcoidosis lesions. All patients were African-American (five females and two males). All patients had ulcers surrounded by atrophic necrobiosis lipoidica-like plaques on the pretibial areas. All patients had other mucocutaneous manifestations of sarcoidosis, with the majority having evidence of internal disease. Combined immunosuppressive and immunomodulatory therapy was effective in controlling the cutaneous manifestations of all patients with ulcerative sarcoidosis. Conclusions. The ulcerative variant is a poorly defined subset of cutaneous sarcoidosis. Trauma, superimposed on atrophic plaques, appears to be the principal mechanism of this rare variant of cutaneous sarcoidosis.

Original languageEnglish (US)
Pages (from-to)108-112
Number of pages5
JournalInternational Journal of Dermatology
Volume43
Issue number2
DOIs
StatePublished - Feb 1 2004

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Sarcoidosis
Skin
Ulcer
Necrobiotic Disorders
Necrobiosis Lipoidica
Skin Manifestations
Chronic Granulomatous Disease
Immunomodulation
Respiratory Function Tests
Peptidyl-Dipeptidase A
Immunosuppressive Agents
Dermatology
Skin Diseases
Radiography
African Americans
Electrocardiography
Thorax
Referral and Consultation
Biopsy
Wounds and Injuries

ASJC Scopus subject areas

  • Dermatology

Cite this

Yoo, S. S., Mimouni, D., Nikolskaia, O. V., Kouba, D. J., Sauder, D. N., & Nousari, C. H. (2004). Clinicopathologic features of ulcerative-atrophic sarcoidosis. International Journal of Dermatology, 43(2), 108-112. https://doi.org/10.1111/j.1365-4632.2004.01896.x
Yoo, Simon S. ; Mimouni, Daniel ; Nikolskaia, Olga V. ; Kouba, David J. ; Sauder, Daniel N. ; Nousari, Carlos H. / Clinicopathologic features of ulcerative-atrophic sarcoidosis. In: International Journal of Dermatology. 2004 ; Vol. 43, No. 2. pp. 108-112.
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Yoo, SS, Mimouni, D, Nikolskaia, OV, Kouba, DJ, Sauder, DN & Nousari, CH 2004, 'Clinicopathologic features of ulcerative-atrophic sarcoidosis', International Journal of Dermatology, vol. 43, no. 2, pp. 108-112. https://doi.org/10.1111/j.1365-4632.2004.01896.x

Clinicopathologic features of ulcerative-atrophic sarcoidosis. / Yoo, Simon S.; Mimouni, Daniel; Nikolskaia, Olga V.; Kouba, David J.; Sauder, Daniel N.; Nousari, Carlos H.

In: International Journal of Dermatology, Vol. 43, No. 2, 01.02.2004, p. 108-112.

Research output: Contribution to journalArticle

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T1 - Clinicopathologic features of ulcerative-atrophic sarcoidosis

AU - Yoo, Simon S.

AU - Mimouni, Daniel

AU - Nikolskaia, Olga V.

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AU - Sauder, Daniel N.

AU - Nousari, Carlos H.

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N2 - Background. Sarcoidosis is a chronic granulomatous disease of unknown etiology. Cutaneous disease is common and includes two clinicopathologic categories: granulomatous infiltration or a reactive phenomenon. In the granulomatous infiltrative group, clinical manifestations can be variable. Ulcers in sarcoidosis are uncommonly recognized and have been categorized previously under the rubric of atrophic, necrobiosis-like, or ulcerative sarcoidosis. Patients and methods. We evaluated retrospectively sarcoidosis patients presenting to the Johns Hopkins Department of Dermatology between June 1989 and May 2002. Multiple skin biopsies were performed for histopathologic evaluation. Investigation for extracutaneous manifestations, including routine serologic assays, chest radiography, pulmonary function tests, electrocardiogram, and angiotensin-converting enzyme level, and referral for ophthalmologic examination were performed in all patients. Results. Of 147 consecutive patients presenting with cutaneous sarcoidosis, seven demonstrated ulcerative-atrophic sarcoidosis lesions. All patients were African-American (five females and two males). All patients had ulcers surrounded by atrophic necrobiosis lipoidica-like plaques on the pretibial areas. All patients had other mucocutaneous manifestations of sarcoidosis, with the majority having evidence of internal disease. Combined immunosuppressive and immunomodulatory therapy was effective in controlling the cutaneous manifestations of all patients with ulcerative sarcoidosis. Conclusions. The ulcerative variant is a poorly defined subset of cutaneous sarcoidosis. Trauma, superimposed on atrophic plaques, appears to be the principal mechanism of this rare variant of cutaneous sarcoidosis.

AB - Background. Sarcoidosis is a chronic granulomatous disease of unknown etiology. Cutaneous disease is common and includes two clinicopathologic categories: granulomatous infiltration or a reactive phenomenon. In the granulomatous infiltrative group, clinical manifestations can be variable. Ulcers in sarcoidosis are uncommonly recognized and have been categorized previously under the rubric of atrophic, necrobiosis-like, or ulcerative sarcoidosis. Patients and methods. We evaluated retrospectively sarcoidosis patients presenting to the Johns Hopkins Department of Dermatology between June 1989 and May 2002. Multiple skin biopsies were performed for histopathologic evaluation. Investigation for extracutaneous manifestations, including routine serologic assays, chest radiography, pulmonary function tests, electrocardiogram, and angiotensin-converting enzyme level, and referral for ophthalmologic examination were performed in all patients. Results. Of 147 consecutive patients presenting with cutaneous sarcoidosis, seven demonstrated ulcerative-atrophic sarcoidosis lesions. All patients were African-American (five females and two males). All patients had ulcers surrounded by atrophic necrobiosis lipoidica-like plaques on the pretibial areas. All patients had other mucocutaneous manifestations of sarcoidosis, with the majority having evidence of internal disease. Combined immunosuppressive and immunomodulatory therapy was effective in controlling the cutaneous manifestations of all patients with ulcerative sarcoidosis. Conclusions. The ulcerative variant is a poorly defined subset of cutaneous sarcoidosis. Trauma, superimposed on atrophic plaques, appears to be the principal mechanism of this rare variant of cutaneous sarcoidosis.

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