Clinical Phenotypes and Therapeutic Responses in Cutaneous‐Predominant Sarcoidosis Clinical and Experimental Dermatology

TAKE-HOME MESSAGE

• In a cohort of 47 patients with cutaneous sarcoidosis, 89% had systemic involvement, and 94% required systemic therapy. There were no cases of spontaneous resolution of skin findings. The best treatment response was seen with methotrexate, with 88% achieving remission, compared with only 40% of those treated with hydroxychloroquine.

• Methotrexate significantly increased the likelihood of achieving clinical remission compared with hydroxychloroquine, azathioprine, or mycophenolate mofetil in patients with cutaneous sarcoidosis.

–  Caroline K. Crabtree, MD

Abstract 

BACKGROUND

There is a limited evidence base for the treatment of cutaneous sarcoidosis.

OBJECTIVE

To describe treatment modalities and responses in patients with predominantly cutaneous sarcoidosis, in addition to clinical characteristics and prevalence of systemic disease.

METHODS

Data were prospectively collected over a 6-year period. The Cutaneous Sarcoidosis Activity and Morphology Index was used to assess treatment effectiveness.

RESULTS

In total, 47 patients with biopsy-confirmed cutaneous sarcoidosis were identified. Morphologically, the most common lesions were papules (49%) and plaques (42.6%). The most commonly affected sites were the head and neck (79%); 89.4% had systemic as well as cutaneous disease; 77% received systemic corticosteroid therapy, while 87% required further steroid-sparing treatment; 40% achieved clinical remission with hydroxychloroquine (HCQ) and 88% achieved clinical remission with methotrexate (MTX). OR of achieving remission on MTX compared with HCQ was 9.8 (95% CI 2.4-40.4, P = 0.001). MTX was superior to both azathioprine (AZA) (OR = 22; 95% CI 1.7-285.9; P = 0.02) and mycophenolate mofetil (MMF) (OR = 22; 95% CI 1.7-285.9; P = 0.02) in achieving remission.

CONCLUSION

HCQ is effective and well-tolerated. MTX was associated with significantly increased probability of achieving clinical remission compared with AZA and MMF.

Clinical and Experimental Dermatology

Clinical Phenotypes and Therapeutic Responses in Cutaneous‐Predominant Sarcoidosis: 6‐Year Experience in a Tertiary Referral Service

Clin Exp Dermatol 2021 Feb 19;[EPub Ahead of Print], A Paolino, J Galloway, S Birring, P Brex, G Larkin, A Patel, D Sado, F Murgatroyd, S Walsh

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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