Sarcoidosis and your skin: Signs and symptoms

Where does sarcoidosis appear on the skin?

This disease can appear anywhere on the skin. Most often, you’ll see it on your:

• Face, especially around the eyes or mouth or on the nose

• Neck

• Upper body, legs, or arms

• Skin that has a scar, tattoo, or piercing

Skin sarcoidosis can also cause changes to your nails, mouth sores, or hair loss.

What does sarcoidosis look like on the skin?

Sarcoidosis can appear on the skin in many ways. The following pictures show some ways this disease can affect the skin or nails.

Small bumps

A common sign of sarcoidosis on the skin, especially among African American women, these bumps tend to develop on the face (often around the eyes) or neck. Called papules, the bumps can be reddish brown, violet, tan, brown, or the same color as your skin. They’re usually painless.

Raised patch(es)

Called a plaque, this raised patch can feel smooth or scaly. The color varies, but most tend to be reddish brown, purple, or brown. Plaques usually develop on the face, scalp, arms, back, legs, or buttocks. As plaques heal, they can cause scarring. When this happens on the scalp, it may lead to hair loss.

Bumps, patches, and discolored skin

Some people develop firm bumps and patches like the ones shown on this woman’s face and neck. On darker skin tones, these patches and bumps can be darker or lighter than a person’s natural skin tone. People with lighter skin tones tend to have red or pink discoloration.

Lumps under the skin

One or more lumps that sit deep in the skin can develop. Called nodules, these lumps usually develop on the arms and can be painless or feel slightly tender. This patient developed nodules on her shoulder, along with raised patches.

Rash

For some people, sarcoidosis begins with a tender-feeling rash called erythema nodosum. The rash usually develops on the shins, but it can appear elsewhere. Seeing this rash isn’t a sure sign that you have sarcoidosis. Other diseases can cause this rash. If you have sarcoidosis, this rash usually means that the sarcoidosis will clear on its own within a few weeks to months. Sarcoidosis can also come and go for a few years, but it’s rarely serious.

Rash with fever and other symptoms

Some people who develop a rash also have a fever, fatigue, swollen lymph nodes (often called glands), arthritis, and other symptoms. This is known as Löfgren syndrome, which may also cause painful lumps, especially on the shins. Löfgren syndrome is a sign that the sarcoidosis will likely clear on its own within a few weeks to months.

Change to a scar (left), tattoo (right), or body piercing

Sarcoidosis can develop in a scar, tattoo, or piercing. When it does, it often causes one or more tiny bumps. The affected skin may feel lumpy, firmer than normal, sore, or itchy. Some people develop discolored skin and swelling.

Smooth, shiny lumps and raised patches

These tend to form on the head and neck, especially on the nose, lips, and cheeks. The medical name is lupus pernio, but it has nothing to do with lupus. If you see these raised patches or lumps, it’s important to see a dermatologist. Treatment can prevent worsening of sarcoidosis on the skin. Your dermatologist will also refer you to other doctors who can tell you whether you have sarcoidosis in your lungs or other organs.

Nail changes

When sarcoidosis affects the nails, it can discolor the nail, cause the nail to lift up, or deform some nails. It can also destroy the nail and cause swollen fingers or toes.

If you have sarcoidosis on your skin, you may also notice one or more of these symptoms where you have sarcoidosis on your skin:

• Itchy skin

• Swelling on your skin

• Skin feels warm to the touch

• Tenderness or pain

You can also have sarcoidosis on your skin, without having any symptoms like itch or tenderness.

Why some people develop sarcoidosis is still a bit of a mystery. While doing research to answer this question, researchers discovered that some people are more likely to develop it than others. To see if you have an increased risk, go to: Sarcoidosis and your skin: Causes.

Images
Images 1, 13: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol. 2012;66:e1-18.)

Image 2: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol. 2013;68:765-73.)

Images 3, 11, 14: Used with permission of DermNet NZ.

Image 4: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol. 2014;70:111-3.)

Images 5, 6; Used with permission of the JAAD Case Reports. (JAAD Case Rep. 2017 Apr 14;3(3):208-11.)

Image 7: Used with permission of the JAAD Case Reports. (JAAD Case Rep. 2020 Apr 25;6(4):348-350.)

Image 8, 12: Used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Image 9: Used with permission of the Journal of the American Academy of Dermatology. (J Am Acad Dermatol. 2003;49:75-8.)

Image 10: Used with permission of the JAAD Case Reports. (JAAD Case Rep. 2016 Apr 15;2(2):146-9.)

References
Ahmed I, Harshad SR. “Subcutaneous sarcoidosis: Is it a specific subset of cutaneous sarcoidosis frequently associated with systemic disease?” J Am Acad Dermatol. 2006;54(1):55-60.

Hubail A, Belkharoeva R, et al. “Lupus pernio (Besnier-Tenneson syndrome): A rare form of sarcoidosis.” Dermatol Reports. 2018 Oct 1;10(2):7696.

Jadotte YT, Abdel Hay R, et al. “Interventions for cutaneous sarcoidosis.” Cochrane Database Syst Rev. 2018 Aug 20;2018(8):CD010817.

Redissi A, Penmetsa GK, et al. “Lupus pernio.” StatPearls Publishing LLC. Page last updated 7/11/2022. Last accessed 2/27/2023.

Wu JH, Imadojemu S, et al. “The evolving landscape of cutaneous sarcoidosis: Pathogenic insight, clinical challenges, and new frontiers in therapy.” Am J Clin Dermatol. 2022 Jul;23(4):499-514.

Written by:
Paula Ludmann, MS

Reviewed by:
Arturo R. Dominguez, MD, FAAD
Neelam Khan, MD, FAAD
Ivy Lee, MD, FAAD

Last updated: 3/24/23