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Background: Sarcoidosis is a granulomatous disease of unknown etiology but is theorized to result from immune overactivity in the setting of an environmental or genetic trigger. It most commonly affects the lungs and lymph nodes but can affect other organ systems, with cutaneous involvement in 30% of patients. The granulomas associated with sarcoidosis lead to increased activity of angiotensin‐converting enzyme (ACE) and 1α‐hydroxylase resulting in an uncontrolled synthesis of 1,25‐dihydroxyvitamin D3 by macrophages, along with elevated serum ACE and calcium levels. Serum ACE and calcium levels are frequently ordered when a patient is diagnosed with cutaneous sarcoidosis. However, their clinical utility in this setting remains unknown. Methods: In this retrospective chart review, we assessed serum ACE and calcium levels in 19 patients with cutaneous sarcoidosis diagnosed by histopathology without preceding evidence of systemic involvement. Serum ACE and calcium levels were also investigated as markers in the progression from mono‐organ cutaneous sarcoidosis to systemic sarcoidosis. Results: No patients with biopsy‐proven cutaneous sarcoidosis had abnormal levels of serum calcium at presentation in a cohort of 17 patients at a single institution. An abnormally elevated ACE level was only seen in one of 13 patients presenting with cutaneous sarcoidosis. Conclusions: Our data suggest that serum ACE and calcium levels are not reliable markers of either cutaneous sarcoidosis or the progression to systemic sarcoidosis. [ABSTRACT FROM AUTHOR]

A 54-year-old female presented to the outpatient clinic with multiple skin lesions on both legs and hair loss affecting a large area of the scalp. Yet, our case had both scalp and leg lesions with concomitant diabetes, hypothyroidism, and old hepatitis B infection. Cutaneous sarcoidosis clinically mimicking necrobiosis lipoidica in a patient with systemic sarcoidosis. Sarcoidosis can affect any part of the skin and presents clinically with a wide array of lesions including papules, nodules, erythema nodosum-like lesions, and lupus pernio.1,2 Involvement of the scalp with sarcoidosis is a rare event that is commonly accompanied by cicatricial alopecia.3 Identification of more than 25 specific and nonspecific variants makes cutaneous sarcoidosis a great imitator to various dermatoses.1,2 Necrobiosis lipoidica (NL)-like sarcoidosis is a peculiar rare variant of sarcoidosis that mimics NL clinically, pathologically, or both clinically and pathologically. [Extracted from the article]

Background: Although tetracycline has been used to treat cutaneous sarcoidosis, the mechanism of action for this treatment remains unclear. This study evaluated the efficacy of minocycline treatment on cutaneous sarcoidosis and the relationship between its efficacy and the presence of Propionibacterium acnes in skin sarcoid lesions. Methods: We retrospectively reviewed results in 13 patients with cutaneous sarcoidosis treated with minocycline at Saitama Medical Center between 2010 and 2017. To demonstrate the presence of P. acnes in the skin lesions, skin biopsy specimens from 11 of the 13 patients were evaluated with immunohistochemistry using a specific monoclonal antibody against P. acnes (PAB antibody). Results: Of the 13 patients treated with minocycline, six patients (46%) achieved a complete response (CR) and seven (54%) had a partial response (PR). The skin lesions regressed in 1.5–5 months (average, 3.2 months) after treatment with minocycline. No relapse had occurred during the minocycline therapy. Elevated serum angiotensin‐converting enzyme levels were observed in five of the patients, and the levels reduced after treatment with minocycline. P. acnes, identified as round bodies that reacted with PAB antibody, were observed in the skin sarcoid granulomas in all patients tested. The number of PAB‐positive round bodies was significantly higher in the skin lesions of patients who had CR than in those who had PR. Conclusions: These results suggest the effectiveness of minocycline for the treatment of cutaneous sarcoidosis and an association of P. acnes with the efficacy of minocycline therapy for cutaneous sarcoidosis. [ABSTRACT FROM AUTHOR]

Dear Editor, A 57-year-old woman was diagnosed with sarcoidosis based on iritis, increased serum levels of angiotensin converting enzyme (ACE) and lysozyme, and bilateral hilar lymphadenopathy on chest x-ray and computed tomography scan 1 year and 3 months previously, and was under follow-up at the Respiratory Medicine and Ophthalmology Departments. Although she had been diagnosed with sarcoidosis, no skin lesions suggestive of sarcoidosis were observed. [Extracted from the article]

A 36-year-old, otherwise healthy Indian man presented with persistent asymptomatic, skin-colored, firm papules and nodules over the helical rim of the pinna and above the concha of the right ear only (Fig.). Diagnosis Histoid leprosy Discussion Histoid leprosy (HL) is a rare type of multibacillary leprosy, first described in 1960 by Wade.[1] It is characterized by typical clinical, histopathologic, immunologic, and bacteriologic findings. Rarely, it can occur I de novo. i [2] The exact etiopathogenesis of HL is unknown, but the abundant bacilli in histoid lesions is thought to be because of the focal loss of immunity.[2] HL is characterized by cutaneous and/or subcutaneous nodules and papules, which are painless, shiny, firm or succulent, discrete, smooth, and skin-colored to brown with apparently normal skin surrounding it. [Extracted from the article]

Immunotherapy is becoming one of today's most important systemic treatments in oncology after demonstrating its efficacy and acceptable tolerance in many types of cancer.[1] However, with increasing patient exposition, new side effects appear, including cutaneous ones. This granulomatous reaction, as triggers, could induce widespread reactions in other black tattoos, called a "rush phenomenon".[5] The granulomatous reactions related to immunotherapy, whether cutaneous or systemic, correspond to a real entity that is still poorly understood. 5 Sepehri M, Hutton Carlsen K, Serup J. Papulo-nodular reactions in black tattoos as markers of sarcoidosis: study of 92 tattoo reactions from a hospital material. [Extracted from the article]