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This article evaluates the use of pentoxifylline (PTX) in the treatment of necrobiosis lipoidica (NL), a chronic granulomatous disease characterized by yellow-brown plaques with elevated violaceous rims on the anterior pretibial region. The study includes a retrospective case series of 10 patients who were treated with PTX. The results show that PTX was well-tolerated, but its effectiveness in treating NL was limited. While this study has limitations, such as a small sample size and non-standardized outcome measures, PTX may be considered as a treatment option for NL. [Extracted from the article]

A 45-year-old man from Pakistan presented with two raised and nodular plaques on his left arm that had been present since birth. He habitually scratched the lesions. The patient had no relevant medical history and denied contact with animals or recent travel. Biopsies revealed granulomatous inflammation, and further testing confirmed the presence of Mycobacterium tuberculosis (Mtb). The patient received antituberculosis therapy, leading to significant improvement in the skin lesions. This case highlights the importance of considering cutaneous Mtb in cases of chronic lesions with non-necrotizing granulomas and emphasizes the need for tissue culture to confirm the diagnosis and initiate prompt treatment. [Extracted from the article]

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]

Exam revealed four asymptomatic well-circumscribed waxy tan dermal nodules with central atrophy and prominent overlying superficial telangiectasias scattered along his scalp measuring between 0.9 and 2.6 cm (Figure 1). In summary, ANL should enter diagnostic consideration for patients presenting with dermal atrophic nodules or arcuate plaques of the scalp. An 85-year-old well-appearing Caucasian gentleman with high blood pressure and hypercholesterolemia presented to clinic for his routine annual skin check. [Extracted from the article]

Blau syndrome is a rare autosomal dominant genodermatosis caused by mutations in the NOD2 (also known as CARD15) and is clinically characterized by idiopathic granulomatous inflammation of multiple organs, mainly the skin, eyes, and joints.[[1]] Cutaneous manifestations of Blau syndrome are discrete, small lichenoid papules or ichthyosiform eruptions on the extremities and trunk.[[2], [4]] Histopathology typically reveals non-caseating epithelioid cell granulomas in the dermis, and thus Blau syndrome is considered to overlap with early-onset sarcoidosis. The present case is the second of I P. acnes i detected in the lesional skin of Blau syndrome; however, there are a few points that should be clarified, that is, whether I P. acnes i is distributed through the disseminated papular lesions or the route of I P. acnes i invasion in juvenile-onset sarcoidosis, and further studies are necessary. They speculated that the mechanism of sarcoid granuloma formation in Blau syndrome may be the result of NOD2 hyperactivity in the presence of MDP, which is a component of I P. acnes i . [Extracted from the article]

Interferon-gamma (IFN- ) expressing T-helper lymphocytes have been hypothesized to play a central role in idiopathic granuloma annulare (GA) pathogenesis, leading to constitutive Janus kinase-Signal transducer and activator of transcription (JAK-STAT) pathway activation.[1] Here, we report three cases of immunotherapy-associated GA that exhibit JAK-STAT activation on immunohistochemistry, suggesting a potential shared mechanism with sporadic GA. Granulomatous/sarcoid-like lesions associated with checkpoint inhibitors: a marker of therapy response in a subset of melanoma patients. While patient 3 developed GA prior to treatment with pembrolizumab, it is interesting to note that she had a significant worsening of GA during treatment with pembrolizumab. [Extracted from the article]

A 22-year-old male with human immunodeficiency virus (HIV) infection presented to the outpatient clinic in March 2021 with an 8-month history of multiple nodular lesions on the upper and lower limbs. Granulomatous secondary syphilis may resemble all these differential diagnoses, as they can have a similar clinical presentation with red-purple macules, papules, plaques, tumors, and nodules. The classic cutaneous presentation of secondary syphilis is a symmetrical non-tender macular rash, erythematous or copper-colored, on the trunk, extremities, palms, and soles.[1] Nevertheless, secondary syphilis has a highly versatile cutaneous presentation; a more aggressive or atypical presentation has been reported among patients with HIV infection.[2] Granulomatous infiltration is a rare finding in secondary syphilis, with few cases reported in the literature. [Extracted from the article]

This article discusses a case of disseminated sporotrichosis with pulmonary involvement in an immunocompromised man. Sporotrichosis is a chronic infection caused by fungi from the genus Sporothrix, with the cutaneous lymphatic form being the most common presentation. Disseminated sporotrichosis is rare and typically occurs in individuals with chronic pulmonary disease, alcohol abuse, diabetes mellitus, sarcoidosis, or immunocompromised states. Pulmonary sporotrichosis can present as primary pulmonary disease or as part of multifocal sporotrichosis in immunocompromised patients. The article emphasizes the importance of accurate and timely diagnosis to prevent inappropriate treatment and improve patient prognosis. [Extracted from the article]

This article presents a cross-sectional analysis of the association between psoriasis and inflammatory bowel disease (IBD) using data from the All of Us Research Program. The study included over 300,000 participants and found that individuals with psoriasis had a significantly higher risk of IBD, as well as Crohn's disease (CD) and ulcerative colitis (UC) individually. The results suggest a potential genetic link between psoriasis and IBD, as well as overlapping inflammatory pathways. The study acknowledges limitations in the use of electronic health record codes and the cross-sectional nature of the analysis. The findings highlight the importance of early diagnosis and appropriate treatment for patients with both IBD and psoriasis. [Extracted from the article]

The isolated plaque being hypoesthetic with sloping margins made us suspect leprosy; however, the unusual presentation of alopecia considering the fact that leprosy usually spares warm, vascular areas like scalp also compelled us to consider other close differentials like sarcoidosis, discoid lupus erythematosus (DLE), alopecia mucinosa, and morphea. There have been less than 10 reports of paucibacillary leprosy involving the scalp, out of which three also had patchy alopecia.[[2], [4]] Alopecia can be a presentation of leprosy and should be considered as a differential in endemic areas with such unusual presentations. A 35-year-old female presented with a single edematous area of hair loss over the left side of the scalp since 6 months. [Extracted from the article]

Following the resolution of herpes zoster, it is important to consider chronic, active VZV infection in immunocompromised patients that present with new onset skin lesions, in addition to isotopic responses. Histopathology findings of herpetic viral cytopathic change and positive VZV immunostaining indicated active VZV infection. Granulomatous dermatitis is one of many cutaneous lesions that can develop following herpes zoster infection. [Extracted from the article]

This article discusses a rare case of morpheaform sarcoidosis, a type of cutaneous sarcoidosis, in a 16-year-old Indian girl. The girl presented with multiple well-defined erythematous to hyperpigmented indurated plaques arranged in a linear pattern on her right forearm, arm, thigh, and leg. The lesions resembled morphea, but histopathology revealed the presence of non-caseating granulomas, leading to a diagnosis of morpheaform sarcoidosis. This is the first reported case of morpheaform sarcoidosis from the Indian subcontinent. The article emphasizes the importance of considering sarcoidosis in the differential diagnosis of indurated skin lesions to prevent complications. [Extracted from the article]

Sarcoidosis is a disease that can affect a multitude of organs and manifest as cutaneous disease. Cutaneous manifestations of sarcoidosis vary widely in morphology, earning the nickname of "great imitator," and the diagnosis often requires clinicopathologic correlation and additional laboratory and radiographic workup. We present the case of a 42‐year‐old African American woman with ichthyosiform sarcoidosis on the bilateral lower extremities. As one of the rarest specific variants of cutaneous sarcoidosis, ichthyosiform is understudied and has been primarily documented in case reports and series. We undertake a comprehensive review of the literature to identify key clinicopathologic features including the characterization of sites of cutaneous and systemic involvement, as well as typical histopathological findings. Lower extremities were the most involved body site (85.7%). Extracutaneous organ involvement centered around pulmonary (65.7%), lymph node (57.1%), and ocular (31.4%) involvement. Of the histopathological features reported, hyperkeratosis (51.4%) and diminished stratum granulosum (62.9%) were most frequently reported in conjunction with dermal granulomas (100%). We hope that these findings will serve to aid clinicopathological correlation and accurate diagnosis of ichthyosiform sarcoidosis. [ABSTRACT FROM AUTHOR]

Background: Macrocheilia is an inflammatory disfiguring condition responsible for the swelling of the lips. This multi‐etiological entity represents a diagnostic and therapeutic challenge. Published data on macrocheilia is scarce, often limited to granulomatous cheilitis. Methods: We conducted a retrospective study, including all patients presenting with chronic macrocheilia (CM) for nineteen years. CM was defined as a persistent enlargement of one or both lips for at least eight weeks. Both descriptive and analytical analyses were performed. Results: Of the 47 patients identified, 20 (43%) had cutaneous leishmaniasis, 10 (21%) had Miescher's cheilitis, five (11%) had Melkersson–Rosenthal syndrome, five (11%) had sarcoidosis, one (2%) had lepromatous leprosy, one (2%) had systemic amyloidosis, and one (2%) had Crohn's disease. In four cases, the CM was unlabeled. Ulcerations were significantly associated with leishmaniasis (P < 0.05). Histological study showed a granulomatous infiltrate in 72% of cases. Medical treatment was adapted to the etiology of CM. Surgery was performed in two cases. Improvement of CM secondary to leishmaniasis was seen in all cases. In patients with idiopathic orofacial granulomatosis, partial improvement was noted in four cases and a total improvement in one case. Recurrences were noted in three cases after complete regression. Conclusions: Macrocheilia is a rare and disfiguring condition that requires an etiological investigation, considering that it can reveal a serious underlying systemic disease. We identified several factors that could help recognize the cause of CM, including age, history of intermittent swelling, the extent of lip enlargement, the existence of ulceration, and systemic symptoms. [ABSTRACT FROM AUTHOR]

Background: Lichen scrofulosorum (LS) represents immunologic reaction to the Mycobacterium tuberculosis antigen and presents with subtle, asymptomatic, grouped follicular papules over the trunk and shows good therapeutic response to antitubercular drugs. Objective: To study the clinical and epidemiological characteristics of patients diagnosed with LS. Materials and Methods: A single‐center retrospective review of patients diagnosed with LS from 1997 to 2018 was conducted. The data pertained to clinico‐epidemiological profile, BCG vaccination, Mantoux positivity, laboratory investigations, coexistent focus of tuberculosis, and response to antitubercular treatment (ATT). Results: LS cases constituted 15.2% (221/1458) of all the patients diagnosed with cutaneous tuberculosis (CTB). Of these, 156 (70.5%) were pediatric patients. All patients presented with multiple follicular and perifollicular grouped papules. The trunk was the most common site involved (98.6%), followed by lower limb (25.33%), upper limb (15.83%), face (5%), and external genitalia (3.6%). Evidence of BCG vaccination and Mantoux test positivity was observed in 52.03 and 83.2%, respectively. Coexistent TB focus was detected in 134 (60.6%) patients in lymph nodes, lungs, abdomen, and unusual sites such as intracranial, endometrium, and eye. Twenty‐eight patients (12.66%) had coexistent other clinical forms of CTB. Clinical diagnosis of LS was confirmed on histology that revealed chiefly periappendageal epithelioid cell granuloma. Response to ATT was good with complete resolution of lesion in 8–12 weeks. Conclusion: LS appears to be an underdiagnosed entity. Subtle and asymptomatic lesions of LS are often missed, thereby necessitating a high index of suspicion and appropriate evaluation of the underlying TB focus. [ABSTRACT FROM AUTHOR]

Although the pathogenesis of GA is not fully understood, the inhibition of T lymphocytes by MMF likely leads to a reduction in the inflammatory response that underlies GA lesions. Granuloma annulare (GA) is a benign inflammatory condition with an etiology that is not fully understood. [Extracted from the article]

Three years later, she returned having continued the hydroxychloroquine therapy for 10 months; she reported that while her pruritus and pain were diminished on the therapy, the frequency of the rash was unaffected and lesions typically recurred in the same locations. These histologic findings in the setting of a figurate erythema supported the diagnosis of chronic recurrent annular neutrophilic dermatosis (CRAND). A woman in her 50s presented with a 1-month history of a painful and pruritic eruption on her lower legs and right upper arm. [Extracted from the article]

Necrobiosis lipoidica (NL) is a granulomatous inflammatory skin disease that mainly affects middle-aged women and usually manifests on the extensor sides of the lower legs. Because of insufficient therapy response and the progression of the ulcers, we started a therapy with the TNF-alpha inhibitor adalimumab with a loading dose of 80 mg subcutaneously followed by 40 mg every 2 weeks. Histologically, NL is characterized by collagen degeneration, granuloma formation, and perivascular inflammatory infiltrate.1 The therapy of NL is challenging, especially in cases of extensive ulceration. [Extracted from the article]

The right eyebrow nodule was surgically removed, and the anatomopathological examination was identical to the previous one; mycobacteriological culture was negative whereas I Cutibacterium acnes i was isolated on bacteriological cultures. Anatomopathological examination of the forehead lesion disclosed multiple epithelioid and giant-cell granulomas with central necrosis and Langhans giant cells in the dermis layer (Fig. Dear Editor, A 75-year-old woman with a negative medical history was admitted to the hospital for a nodule of the glabella, then of the right eyebrow arch, mandible, and preauricular area (Fig. [Extracted from the article]

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]

Based on the clinical and histological findings, a diagnosis of extrafacial granuloma faciale (GF) was made. Dear Editor, A previously healthy 76-year-old Caucasian male was referred to our outpatient clinic because of an isolated, skin-colored plaque on the occipital area of the scalp, growing centrifugally. [Extracted from the article]

Granuloma faciale (GF) is a rare inflammatory skin disorder of unknown etiology, which can cause severe cosmetic impairment.[1] GF presents as asymptomatic, solitary or multiple, erythematous nodules and/or plaques, nearly always limited to the face.[[1], [3]] Due to delayed diagnosis, with delays of up to 15 years reported, the disease may gradually/eventually progress to disseminated or extrafacial GF.[2] Herein, we report an unusual case of GF with extensive lesions (covering 70% of the facial area) and extrafacial involvement, a condition which has rarely been described. Granuloma faciale (GF) is an idiopathic cutaneous disorder of unknown etiology, predominantly affecting the face but may infrequently appear on the trunk, scalp, or extremities.[1] GF usually manifests as localized, well-delimited plaques and nodules at one single site. This suggests that it is still necessary to increase vigilance against the disease and perform skin biopsies on any chronic erythematous plaques or nodules for early diagnosis, so as to avoid the serious consequences of disease progression. [Extracted from the article]

Palisaded neutrophilic granulomatous dermatitis leading to diagnosis of hodgkin lymphoma: report of rare case and literature review of paraneoplastic granulomatous dermatitides. Multiple granulomatous skin eruptions have been linked to hematologic malignancies.[1] The first presenting feature of a hematologic malignancy may be a granulomatous skin eruption, preceding the formal diagnosis of leukemia by multiple years.[[1]] Here, we present a unique case of reactive, non-interstitial granulomatous dermatitis that first presented approximately 1 year prior to the patient's diagnosis of myelodysplastic syndrome (MDS) and showed marked improvement within 3 months of treatment with hydroxychloroquine. Hydroxychloroquine has also been successfully used to treat cases of interstitial granulomatous dermatitis.[6] In summary, we present a case of reactive, non-interstitial granulomatous dermatitis that appeared 1 year prior to MDS, treated with hydroxychloroquine. [Extracted from the article]

Predominant epidermal scaling and follicular plugging seen in the index patient are soft pointers toward LV vis-à-vis lupus pernio. However, uncommon variants such as myxomatous form may present as huge soft tumors over the external ear, giving an appearance of "Turkey ear."3 The diagnosis of LV is based on a combination of clinical, dermoscopic, histological, and microbiological findings. LV, a paucibacillary type of cutaneous tuberculosis, usually occurs in immunocompetent individuals and shows a strong tuberculin hypersensitivity. [Extracted from the article]

Due to the efficacy of TCZ in controlling underlying isolated aortitis, treatment was not stopped, and topical steroid treatment was added with only partial benefit. In July 2019, he was started on TCZ 162 mg weekly for a 4-year history of isolated aortitis with coronary involvement, refractory to previous combination therapy with systemic glucocorticoids and methotrexate. Dear Editor, Rheumatoid nodules (RN) are most frequently encountered as extra-articular manifestations of rheumatoid arthritis (RA), involving 25-35% of patients with severe disease.1 However, RN have been also described in association with other inflammatory diseases.1 RN mainly involve the hands, elbows, Achilles tendons, as well as lungs and vocal chords.1 On the contrast, in accelerated nodulosis (AN), nodules are smaller, have a more rapid onset and growth, and usually involve only feet and hands. [Extracted from the article]

Seven months later, the female returned for treatment due to more apparent lip swelling (Fig. (e, f) Complete resolution of lip swelling and intraoral cobblestone formation gl Herein, we describe a healing case of OFG which may be caused by tooth infection with no pharmaceutical application. Dear Editor, Orofacial granulomatosis (OFG) is an uncommon chronic inflammatory disorder which typically presents as recurring lip swelling, ulceration, and a cobblestone appearance of the buccal mucosa.1,2 Histologically, the condition is marked by non-caseating granulomas.1 The treatment of OFG is difficult, particularly in the absence of etiology.3 Therefore, the aim of this study is to report a case of OFG which may be caused by tooth infection, and the healing of the condition was treated with no pharmaceutical application. [Extracted from the article]

A 77-year-old woman with stage IV squamous cell lung carcinoma (SCC) presented with nonhealing, pruritic plaques on the back, right lower leg, and vulva. All biopsies showed pseudoepitheliomatous hyperplasia with dense polymorphous inflammatory infiltrate containing lymphocytes, plasma cells, eosinophils, neutrophils, and histiocytes. [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]

Sarcoidosis is a granulomatous disease that can affect any organ. GLO:DIF/01jan23:ijd16438-fig-0002.jpg PHOTO (COLOR): 2 Nail sarcoidosis associated with a sausage finger appearance characteristic of sarcoidosis dactylitis gl The nail lesions found in sarcoidosis can be explained by the compressive effect of the granuloma on the nail plate and phalanges.[3] Therefore, it is recommended to perform longitudinal biopsies of the nail instead of punch biopsies to confirm the diagnosis. Skin involvement occurs in 20-35% of patients with sarcoidosis, most often at the time of diagnosis.[1] Nail involvement is rare, but its presence is a sign of chronic systemic disease.[2] We report two cases of multisystem sarcoidosis developing nail involvement during the course of the disease. [Extracted from the article]

ICAM-1 deficiency has also been associated with inhibition of epidermal Langerhans cell migration to regional lymph nodes.[9] Treatment of cutaneous sarcoidosis is difficult,[[10]] and lesions can be recalcitrant. Cell Immunol. 1994; 158: 389 - 99. 10 Badgwell C, Rosen T. Cutaneous sarcoidosis therapy updated. Dear Editor, Sarcoidosis, an inflammatory disease of unknown etiology, can involve virtually any organ, but the lungs and hilar lymph nodes are affected in up to 95% of cases. [Extracted from the article]

Interferon gamma release assay for tuberculosis was positive, but his chest x-ray was negative, consistent with his history of treated tuberculosis. Dear Editor, Sarcoidosis is a chronic, inflammatory disease of unclear etiology, classically characterized by an infiltration of noncaseating granulomas.1 It may affect any tissue or organ, but the most commonly affected are the lungs, the lymphatic system, and the skin. For localized disease, intralesional or topical corticosteroid therapy is the preferred first-line treatment.3 Particularly for thicker or nodular lesions, intralesional therapy may penetrate the skin better and yield better results. [Extracted from the article]

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]

Chronic Hansen's disease can cause irreversible neuropathy, with weakness and loss of sensation around lesions and in distributions of the affected nerves. Hansen's disease should be suspected when at least one of the following three cardinal signs are present: loss of sensation in a hypopigmented or erythematous skin patch; thickened or enlarged peripheral nerve with loss of sensation or weakness in the distribution; or the presence of I M i . Neurological examination revealed no swelling of the great auricular nerve, ulnar nerve, median nerve, radial nerve, common peroneal nerve, posterior tibial nerve, or sural nerve. [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]

Approximately 25% of the inflammatory infiltrate showed CD23 SP + sp immunostaining, consistent with the patient's underlying diagnosis of CLL. HZ granulomatous dermatitis in this case should be differentiated from acute HZ infection. Although acute HZ may show a lymphoplasmacytic infiltrate, multinucleated giant cells are more characteristic of a late granulomatous reaction, which favors a diagnosis of HZ granulomatous dermatitis.[1] However, it should be noted that acute HZ shares some histologic features with HZ granulomatous dermatitis and that granulomatous changes can appear in acute HZ presentations within 6 weeks of onset.[1]. [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]

The article focuses on a study related to sarcoidosis of the scalp. Topics discussed include histopathological demonstration of noncaseating granulomatous inflammation together with suggestive clinical and radiological features; pattern of scalp involvement ranged from annular plaques; and treatment of patients with chloroquine.

The article presents a case study of a 50-year-old female with a four-year history of pulmonary and cutaneous sarcoidosis presented with a recent onset of lichenoid, pruritic, scaly papules on both upper lids and infraorbital skin with progressive course. It discusses the diagnosis of Lichenoid papules in the periorbital area.

Sarcoidosis can present with necrotizing granulomas histologically: two cases of ulcerated sarcoidosis and review of the literature. Specific lesions commonly present as reddish-brown infiltrated papules or plaques.2,3 Ulcerated and atrophic lesions are rare, seen worldwide in only 5% of patients with CS.4 Ulceration may arise de novo or in preexisting lesions. Dear Editor, Sarcoidosis is an inflammatory granulomatous disease of unknown etiology. [Extracted from the article]

The article presents a case study of 62-year-old woman who was referred for the suspicion of cutaneous sarcoidosis. Topics discussed include diagnosis of cutaneous sarcoidosis after Hodgkin lymphoma; medical history of stage IIA HL of the left abdominal para-iliac chains; and giant cell granulomas without necrosis or foreign bodies revealed in ultrasound-guided needle biopsy.

Background There are no reliable epidemiological data on sarcoidosis in the French West Indies, although this disease is known to be more frequent and more severe in Black African- Americans and West Indians. Objectives This retrospective study aimed to assess the incidence and prevalence of sarcoidosis in Guadeloupe over a 7-year period and to determine its epidemiological, clinical, and evolutionary characteristics. Methods Patients were identified through the computerized databases of the three pathology laboratories and two hospitals on the islands of Guadeloupe. Histologically proven cases of sarcoidosis were selected. All patients were recalled at a single study time-point. Results A total of 75 patients were identified. These included 44 women and 31 men (sex ratio: 1.4), with a mean ± standard deviation ( SD) age of 47 ± 14 years and Fitzpatrick skin types IV- VI. The average incidence was 2.28 per 100,000 inhabitants per year (95% confidence interval [ CI] 1.69-3.02). The prevalence of sarcoidosis in 2009 was 21.09 per 100,000 inhabitants (95% CI 16.00-26.18). Most patients (61/71, 85.9%) exhibited multiple organ involvement; the mean ± SD number of organs involved was 2.6 ± 1.1. The initiation of systemic therapy was required in 75.7% of cases. Several lines of treatment were necessary in 41.5% of affected patients. At the study time-point, seven patients were found to have died. Four of these deaths were directly attributable to sarcoidosis (mortality rate: 5.3%). Conclusions This epidemiological study on sarcoidosis in Guadeloupe reveals a low incidence of the disease and a high degree of severity as evidenced by the average number of affected organs, the high frequency of extrathoracic organ involvement, the frequent use of corticosteroids, and a mortality rate of 5.3%. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a systemic granulomatous disease characterized by the presence of non-caseating granulomas. Its etiology remains obscure. A plausible hypothesis suggests that a complex interplay of host factors, infectious processes, and non-infectious environmental factors, matched with a susceptible genetic background, results in a pathway that leads to systemic granulomatous inflammation. Although presentations of sarcoidosis vary enormously, multi-organ involvement is a common feature. Cutaneous involvement occurs in about 25% of patients with protean manifestations and variable prognoses. Skin manifestations are divided into specific lesions with histopathologically evident non-caseating granulomas and nonspecific lesions arising from a reactive process that does not form granulomas. A peculiar form of cutaneous sarcoidosis is represented by sarcoidal lesions at sites of trauma that has caused scarring. The pathogenesis of scar sarcoidosis remains unknown. Scar sarcoidosis is also associated with herpes zoster infection, surgery, and tattooing. Such heterogeneous events, along with those at the sites of chronic lymphedema, thermal burns, radiation dermatitis, and vaccinations, occur on areas of vulnerable skin labeled 'immunocompromised districts'. Numerous options are available for the treatment of cutaneous sarcoidosis. Although corticosteroids remain the treatment of choice for initial systemic therapy, other nonsteroidal agents have proven effective and therefore useful for long-term management. Tumor necrosis factor- α antagonists such as infliximab may have a role in the treatment of cutaneous sarcoidosis, especially in refractory cases that are resistant to standard regimens. Elucidation of the relationship of sarcoidal granulomas with malignancy and immunity may facilitate a better understanding of some pathomechanisms operating in neoplastic and immunity-related disorders. [ABSTRACT FROM AUTHOR]

Background Sarcoidosis is a multi-system granulomatous disease of unknown etiology. The skin is involved in 25% of cases. Studies on cutaneous sarcoidosis from our region are lacking. Objectives This study was conducted to describe clinical and histopathologic findings in all patients diagnosed with cutaneous sarcoidosis at the American University of Beirut Medical Center between 1992 and 2010 and to compare findings with those published in the literature. Methods Clinical charts of patients with cutaneous sarcoidosis were retrospectively reviewed. Extracutaneous lesions were classified by organ involvement. Treatment was documented. Pathology specimens were reviewed. Results Cutaneous sarcoidosis was diagnosed in 76 Lebanese patients, 79% of whom were women. Mean age at diagnosis was 48 years. A total of 29% of patients had systemic disease that was commonly associated with lupus pernio lesions and subcutaneous sarcoidosis. The most common cutaneous lesions were sarcoidal plaques. The histopathologic features in our series did not differ from those described in the literature, except for the documented presence of a grenz zone. Interestingly, 23% of biopsy specimens contained perineural granulomas, raising the possibility of tuberculoid or borderline tuberculoid leprosy. Foreign bodies were detected in 10% of cases (all had systemic involvement), supporting the opinion that sarcoidosis and granulomatous foreign body reaction are not mutually exclusive. Conclusions The clinical and histopathologic features of cutaneous sarcoidosis patients in the present series are generally comparable with those published in the literature, with minor differences. Clinically, the most commonly seen lesion was plaque. Microscopically, cutaneous sarcoidosis may exhibit a grenz zone and may show perineural inflammation and foreign bodies. [ABSTRACT FROM AUTHOR]

Sarcoidosis is an idiopathic systemic granulomatous disease, in which non-caseating granulomas formations can occur in any organ. Although rare, involvement of the scalp can occur, which might lead to cicatricial alopecia. Dermoscopic features of scalp sarcoidosis had not been reported. Clinical, dermoscopic, and histopathological features of two patients with scalp sarcoidosis were reviewed. Two Caucasian female patients aged 22 and 60 years old presented with diffuse folliculitis-like lesions and patchy alopecia, respectively. Dermoscopy of the lesions showed decreased hair density associated with perifollicular and follicular yellowish to pale orange round spots in the first case and diffuse orange discoloration with prominent telangiectasia in the second patient. Few dystrophic hairs were seen in both cases. The orange spots seen at trichoscopy of lesions in scalp sarcoidosis may represent a clue to the diagnosis of this condition. Dystrophic hairs may indicate granulomatous activity. [ABSTRACT FROM AUTHOR]

Sarcoidosis is a multisystem granulomatous disease that affects multiple organs in adults between 20 and 50 years old. Interferon alpha (IFN-α) is an immunomodulator that has been used in a wide range of diseases, including hepatitis C virus infection, multiple sclerosis, and other types of neoplasias, including leukemia, lymphoma, Kaposi's sarcoma, and melanoma. Standard IFN-α-induced sarcoidosis has been reported, but there are few reports of cutaneous sarcoidosis with pegylated IFN-α therapy. We present a new case of cutaneous sarcoidosis after treatment with pegylated IFN, and a review of the literature. [ABSTRACT FROM AUTHOR]

The article presents a case report of cutaneous and pulmonary sarcoidosis in a homosexual male patient with HIV after highly active antiretroviral therapy (HAART). The report discusses the highly active antiretroviral therapy and concludes that it does not play a major role in the occurrence of sarcoidosis as some human immunodeficiency virus (HIV) patients had developed sarcoidosis without antiretroviral therapy.

Dear Editor, Tocilizumab is a recombinant, humanized, anti-human IL-6 receptor monoclonal antibody which is FDA-approved for treatment of moderate-to-severe rheumatoid arthritis, polyarticular or systemic juvenile idiopathic arthritis, and giant cell arteritis. There are also some reports showing promising results of Tocilizumab in the treatment of sarcoidosis as a steroid sparing therapy.[[1]] The occurrence, though, of sarcoidosis during treatment with tocilizumab has been increasingly reported.[[2], [4]] Herein, we report a further case of Tocilizumab-induced sarcoidosis-like reaction. To date, four cases of tocilizumab-induced sarcoidosis have been published - three of them referring to patients with rheumatoid arthritis and one case referring to a patient with giant cell arteritis.[[2], [4]] In this case report, we describe a further case of cutaneous sarcoidosis-like reaction during treatment with Tocilizumab that regressed spontaneously after discontinuation of the treatment. [Extracted from the article]

A 40-year-old Caucasian man presented to the dermatology clinic at Baylor College of Medicine, Houston, Texas, in February 2003, for the evaluation of three nonhealing ulcers. The patient’s past medical history was significant for hypothyroidism and pulmonary sarcoidosis, the diagnosis of which was made in June 2000. In March 2000, the patient had complained of cough and shortness of breath. A purified protein derivative (PPD) (Mantoux text) was negative. Computed tomography (CT) scans of the chest revealed diffuse hilar and mediastinal adenopathy and bilateral interstitial and alveolar infiltrates. Although consistent with sarcoidosis, these findings were insufficient to exclude other etiologies, including disseminated fungal infection. Cultures and stains of subsequent bronchoscopy specimens failed to reveal any organisms, and histopathologic evaluation of the specimens was nondiagnostic. Based on the imaging studies and the negative cultures, a diagnosis of sarcoidosis was made, and the patient was started on therapy with prednisone. Before coming to our clinic, the patient had been on several courses of prednisone. In May 2002, the patient had presented to a private dermatologist with a 1-year history of a nonhealing 2.4 cm × 2.0 cm ulcer on the left medial forearm. Two biopsies were reported as nondiagnostic. The patient’s presentation was interpreted as most consistent with Mycobacterium marinum infection, and so he was empirically treated with minocycline. This treatment was continued for almost 3 months without improvement in the ulcer. A few months after the minocycline had been discontinued, the patient was treated empirically for 2 months with ciprofloxacin. This treatment was also unsuccessful in ameliorating the ulcer. In between the two courses of antibiotics, specimens from the lesion were sent for bacterial and fungal cultures, which revealed normal skin flora. In January 2003, the patient returned to his private dermatologist with three ulcerations. In addition to the nonhealing ulcer on his left forearm, which he had acquired several months earlier, he had also developed a 3.0 cm ulcer on his right arm and a 3.0 cm ulcer on his central back. The patient refused biopsies at this visit. Given the patient’s previous diagnosis of pulmonary sarcoidosis, it was thought that the skin lesions might represent ulcerative cutaneous sarcoidosis. Pyoderma gangrenosum was also considered to be a likely diagnosis. Therefore, the patient was started on a course of oral prednisone, an effective therapy for both sarcoidosis and pyoderma gangrenosum. Despite 1 month of treatment with 60 mg/day of prednisone, the ulcers increased, and the patient was subsequently referred to our clinic. Physical examination at the time of presentation revealed steroid acne on the trunk and upper extremities and three nontender ulcers with erythematous, undermined borders ( Figs 1–3 ). On the left arm, there was an adjacent nodule which the patient attributed to a scar from a previously healed ulcer. Histologic examination of biopsy specimens from all three sites showed similar findings. The lesion contained diffuse, suppurative, granulomatous, inflammatory infiltrates with extensive central necrosis. The infiltrates were composed of histiocytes, multinucleated foreign-body-type giant cells, plasma cells, lymphocytes, neutrophils, and neutrophil fragments. No organisms were seen in the initial, routinely stained sections. However, periodic acid–Schiff (PAS) staining demonstrated small fungal spores ( Fig. 4 ) morphologically consistent with sporotrichosis, within the cytoplasm of multinucleated histiocytic giant cells ( Fig. 5 ). Additional stains for bacteria and acid-fast organisms were negative. Cultures of the biopsy specimens from all three sites grew Sporothrix schenckii. Further questioning of the patient failed to reveal an obvious source of the infection. The patient denied any history of traumatic skin inoculation and did not engage in gardening or other outdoor activities that are classically associated with sporotrichosis. The patient did admit to blackberry picking on detailed retrospective questioning. Once the diagnosis of sporotrichosis was made, the patient was given 200 mg/day of itraconazole. After 2 months, the patient’s ulcers were almost completely healed. The patient’s pulmonary complaints were also much improved. [ABSTRACT FROM AUTHOR]

The article presents a commentary on granuloma annulare, relapsing polychondritis, sarcoidosis, and systemic lupus erythematosus. The appearance of some dermatoses has ushered either the diagnosis of a previously unsuspected malignancy or the detection of cancer recurrence in an oncology patient. These involved mucosal and cutaneous conditions are related to as mucocutaneous paraneoplastic syndromes. Granuloma annulare is a chronic dermatosis of uncertain etiology. It can be localized to a specific area of the body or generalized.