Sarcoidosis and your skin: Diagnosis and treatment

When sarcoidosis develops on the skin, it’s often an early sign of the disease. As such, a dermatologist is often the first doctor to notice signs of sarcoidosis.

Signs and symptoms of sarcoidosis can come and go

Keeping track of your symptoms can help your doctors find sarcoidosis.

Can a dermatologist diagnose sarcoidosis?

Yes, if sarcoidosis affects your skin, a dermatologist can diagnose this disease. Your dermatologist knows how to rule out other skin diseases that can look like sarcoidosis.

Here’s what’s involved in diagnosing cutaneous (affects the skin) sarcoidosis.

Your dermatologist will examine your skin, looking for:

• Lumps, bumps, and other signs of sarcoidosis

• Scars and tattoos (sarcoidosis can develop in one)

• Rash, swollen lymph nodes

During the skin exam, your dermatologist is looking for masses of inflamed tissue called granulomas.

How do you test for skin sarcoidosis?

If your dermatologist sees something on your skin that could be sarcoidosis, you’ll need a skin biopsy. Your dermatologist can quickly and safely perform this during your office visit while you remain awake. The skin your dermatologist removes will be examined in a lab under a microscope.

A skin biopsy cannot tell your dermatologist whether you have sarcoidosis. A skin biopsy helps rule out other conditions like an infection. Ruling out other conditions helps your dermatologist diagnose cutaneous sarcoidosis.

Your dermatologist will also ask how you’ve been feeling. Tell your dermatologist about vision changes, eye pain, cough, difficulty breathing, abnormal heart rhythms, and other health issues that you’ve noticed.

Your dermatologist may also send you to other doctors. Sarcoidosis can affect more than the skin.

The other doctors will give you thorough workups. You may need tests, which include a chest X-ray, lung function testing, eye exam, blood tests, and an electrocardiogram (ECG).

No one medical test, such as a blood test or x-ray, can tell a doctor whether you have this disease. For this reason, your doctors will likely discuss the results.

After seeing the necessary doctors, you’ll be told what they found.

If you have sarcoidosis, you may need treatment. Most often, patients receive treatment for the area of the body where sarcoidosis is the worst. For example, if you have sarcoidosis on your skin and in your lungs, you might start with treatment for your lungs. Some patients need treatment for both.

How do dermatologists treat sarcoidosis on the skin?

Mild skin sarcoidosis may go away on its own. If this seems likely, your dermatologist may suggest watching you rather than treating you. Clearing can take a few weeks to a few years.

Dermatologists recommend treating the skin when you have:

• Sarcoidosis on your skin that can cause thickening skin, scarring, or permanent skin damage

• Sarcoidosis bumps on much of your skin

• Symptoms like pain or itch

If you need treatment for your skin, you will receive a treatment plan tailored to your needs. Treatment plans vary with the signs of sarcoidosis on your skin, how much of your skin is covered, your overall health, age, and other considerations.

Here are the treatments for skin sarcoidosis that dermatologists use:

Skin-directed treatment: For many patients, this type of treatment works well. Your dermatologist may prescribe one or more of the following:

• Medication you apply to your skin: Most patients apply a corticosteroid, pimecrolimus cream, or tacrolimus ointment. These medications work to stop the bumps and lesions from developing on your skin. Your dermatologist will tell you how often and for how long you should apply the medication.

• Laser or light therapy: For this to be effective, you may need several treatments and your dermatologist may need to try a few different types of laser or light treatments to find one that works for you.

• Injections of corticosteroids: Your dermatologist will inject this medication directly into the bump or other lesion. These injections can relieve a painful or itchy granuloma. Most patients receive injections every 3 to 4 weeks until the lesions go away.

Treating the skin with medication that works throughout the body: If you need stronger treatment, your dermatologist may prescribe this type of medication. Most of these medications are pills, but some like the biologics are injected.

Medications your dermatologist may prescribe include:

• Hydroxychloroquine or chloroquine: These medications reduce inflammation, which can shrink the lesions on your skin.

• Antibiotic: While you may think of this medication as treatment for an infection, an antibiotic can also reduce inflammation. Reducing inflammation can stop growths from developing on your skin. To improve results, your dermatologist may combine an antibiotic like doxycycline with hydroxychloroquine (see above) or prescribe two antibiotics like azithromycin and doxycycline.

• Methotrexate: This medication can stop sarcoidosis from developing on your skin. If methotrexate is part of your treatment plan, your dermatologist may prescribe pills or give you injections. Methotrexate can be especially helpful if sarcoidosis is causing ulcers on your skin.

• Corticosteroid pills: If you have widespread or disfiguring sarcoidosis on your skin or the disease hasn’t been helped by other treatment, this may be an option. This medication is started at a high dose and gradually tapered down.

• Thalidomide: This medication is prescribed when other treatments haven't worked. Thalidomide works by reducing inflammation, which can clear the skin. You should not take thalidomide if you’re pregnant or could become pregnant. This medication can cause severe birth defects.

• A biologic: This medication can be helpful if sarcoidosis covers much of your skin, is disfiguring, or fails to respond to other treatments. Two biologics, infliximab and adalimumab, have been shown to be beneficial. Before you start this medication, your dermatologist may test you for tuberculosis and lymphoma.

Surgical removal: This is only considered as a possible treatment when a patient has severely disfiguring sarcoidosis and other treatments have failed to work. During surgical removal, your dermatologist cuts out the sarcoidosis on your skin.

Researchers are studying other possible treatments

Sometimes, skin sarcoidosis can be a challenge to treat. This is leading dermatologists and other doctors to study different medications.

One medication that shows promise is called a JAK inhibitor. It’s a newer type of medication that works by interfering with signals in the body that are thought to cause inflammation. This, in turn, could reduce the inflammation that fuels sarcoidosis on the skin.

To help patients with sarcoidosis prevent serious health problems, dermatologists recommend ongoing medical care when sarcoidosis is active. You’ll find the advice that dermatologists give their patients who have sarcoidosis at, Sarcoidosis and your skin: Tips for managing.

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

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