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Occur at any age (20-40 years) Male : female ratio 1:1 Black (females) are more susceptible SARCOIDOSIS MAIN FEATURES : MAIN FEATURES Generalized Affect any organ of the body (except adrenal gland) Similar histological pattern in all affected organs Kveim test is positive in active cases SARCOIDOSIS PATHOPHYSIOLOGY : PATHOPHYSIOLOGY SARCOIDOSIS GRANULOMA : GRANULOMA SARCOIDOSIS GRANULOMA : GRANULOMA SARCOIDOSIS GRANULOMA : GRANULOMA SARCOIDOSIS GRANULOMAdifferentials : GRANULOMAdifferentials TUBERCULOSIS OF SKIN SARCOIDOSIS GRANULOMA differentials : GRANULOMA differentials SARCOIDOSIS TUBERCULOSIS OF SKIN GRANULOMA differentials : GRANULOMA differentials LUPUS VULGARIS SARCOIDOSIS SARCOIDOSIS GRANULOMAdifferentials : GRANULOMAdifferentials TUBERCULOID LEPROSY SARCOIDOSIS SARCOIDOSIS GRANULOMAdifferentials : GRANULOMAdifferentials TUBERCULOID LEPROSY SARCOIDOSIS SARCOIDOSIS GRANULOMAdifferentials : GRANULOMAdifferentials CUTANEOUS LEISHMANIASIS SARCOIDOSIS GRANULOMAdifferentials : GRANULOMAdifferentials FOREIGN BODY GRANULOMA SARCOIDOSIS AFFECTED ORGANS : AFFECTED ORGANS Lungs (90%) Lymph nodes (75%) Liver (60%) Spleen (40%) Skin (25%) Eyes (25%) Musculoskeletal (25%) CNS (5%) Heart (5%) Endocrine system GIT system SARCOIDOSIS CUTANEOUS SARCOIDOSIS : CUTANEOUS SARCOIDOSIS 25% to 35% systemic sarcoidosis Can occur without systemic disease Cutaneous Lesions Specific Granulomas on biopsy Non-specific Reactive SARCOIDOSIS CLASSIFICATION OF CUTANEOUS SARCOIDOSIS : CLASSIFICATION OF CUTANEOUS SARCOIDOSIS SARCOIDOSIS CLASSICAL FORMSERYTHEMA NODOSUM : CLASSICAL FORMSERYTHEMA NODOSUM Sudden onset Painful erythematous nodules Site: shin, knee, ankle Young women Acute and benign stage Involute spontaneously in 2 years Löfgren syndrome Hilar lymphadenopathy Iridocyclitis Erythema nodosum SARCOIDOSIS CLASSICAL FORMSMACULOPAPULAR FORM : CLASSICAL FORMSMACULOPAPULAR FORM Transient maculopapular eruptions Site: Trunk Diascopy Yellow discoloration Lupoid grains SARCOIDOSIS CLASSICAL FORMSMACULOPAPULAR FORMdifferentials : CLASSICAL FORMSMACULOPAPULAR FORMdifferentials ROSACEA SARCOIDOSIS CLASSICAL FORMSPAPULAR FORM : CLASSICAL FORMSPAPULAR FORM Painless,1 to 5 mm First yellowish-brown, later brownish-red Site: Face and extensor aspects of the limbs Merging into an erythematous plaque Diascopy Lupoid grains Favourable prognosis SARCOIDOSIS CLASSICAL FORMSPAPULAR FORMdifferentials : CLASSICAL FORMSPAPULAR FORMdifferentials ACNE AGMINATA SARCOIDOSIS CLASSICAL FORMSPAPULAR FORMdifferentials : CLASSICAL FORMSPAPULAR FORMdifferentials PAPULAR SECONDARY SYPHILIS SARCOIDOSIS CLASSICAL FORMSNODULAR FORM : CLASSICAL FORMSNODULAR FORM Larger than 5 mm Yellowish-red at first, later violaceous Soft and round Proximal limbs, trunk and face SARCOIDOSIS CLASSICAL FORMSANNULAR FORM : CLASSICAL FORMSANNULAR FORM Peripheral evolution and central clearing Centre depigmented and scarred Forehead, face and neck SARCOIDOSIS CLASSICAL FORMSANGIOLUPOID FORM : CLASSICAL FORMSANGIOLUPOID FORM Rare but characteristic Soft and hemispherical nodule Orange-red or reddish-brown colour Site: Side of the bridge of the nose Spontaneous resolution SARCOIDOSIS CLASSICAL FORMSSUBCUTANEOUS FORM : CLASSICAL FORMSSUBCUTANEOUS FORM Painless persistent nodules Site: Extremities Rare Accompanied by Hilar lymphadenopathy SARCOIDOSIS CLASSICAL FORMSSUBCUTANEOUS FORMDIFFERENTIALS : CLASSICAL FORMSSUBCUTANEOUS FORMDIFFERENTIALS TUBERCULOID LEPROSY SARCOIDOSIS CLASSICAL FORMSSUBCUTANEOUS FORMDIFFERENTIALS : LYMPHOCYTOMA CUTIS SARCOIDOSIS CLASSICAL FORMSSUBCUTANEOUS FORMDIFFERENTIALS CLASSICAL FORMSSUBCUTANEOUS FORMDIFFERENTIALS : LUPUS VULGARIS SARCOIDOSIS CLASSICAL FORMSSUBCUTANEOUS FORMDIFFERENTIALS CLASSICAL FORMSPLAQUE FORM : CLASSICAL FORMSPLAQUE FORM Site: Limbs, shoulders, buttocks and thighs Diffuse Persistent SARCOIDOSIS CLASSICAL FORMSPLAQUE FORMDIFFERENTIALS : CLASSICAL FORMSPLAQUE FORMDIFFERENTIALS TERTIARY SYPHILIS SARCOIDOSIS CLASSICAL FORMSPLAQUE FORMDIFFERENTIALS : PSORIASIS SARCOIDOSIS CLASSICAL FORMSPLAQUE FORMDIFFERENTIALS CLASSICAL FORMSPLAQUE FORMDIFFERENTIALS : NECROBIOSIS LIPOIDICA SARCOIDOSIS CLASSICAL FORMSPLAQUE FORMDIFFERENTIALS CLASSICAL FORMSLUPUS PERNIO : CLASSICAL FORMSLUPUS PERNIO Common in women Symmetrical bluish-red and dusky violaceous nodules and plaques Site: Nose, cheeks, ears, fingers, hands and Toes Typical appearance on diascopy Nasal involvement Swelling, ulceration of nasal vestibule Present with difficulty in breathing Lesions seldom resolve SARCOIDOSIS CLASSICAL FORMSLUPUS PERNIODIFFERENTIALS : CLASSICAL FORMSLUPUS PERNIODIFFERENTIALS ROSACEAL RHINOPHYMA SARCOIDOSIS CLASSICAL FORMSSCAR SARCOIDOSIS : CLASSICAL FORMSSCAR SARCOIDOSIS Long-standing scars Inflamed and infiltrated Purplish-red lesions later turn brown Common site knees Histology is typical of sarcoisosis SARCOIDOSIS CLASSICAL FORMSSCAR SARCOIDOSISDIFFERENTIALS : CLASSICAL FORMSSCAR SARCOIDOSISDIFFERENTIALS SARCOIDOSIS KELOID ATYPICAL FORMS : ATYPICAL FORMS HYPOPIGMENTATION Macular Site: limbs Not anaesthetic Histology Non caseating granuloma Melanocyte degeneration ERYTHRODERMIC SARCOIDOSIS Extremely rare Red scaling patches merge into brownish-red sheets Lymphadenopathy SARCOIDOSIS ATYPICAL FORMS : ATYPICAL FORMS MUCOSAL INVOLVEMENT Nasal mucosa Buccal lesions or tongue involvement Plaques, diffuse pale yellow Ulceration NAIL INVOLVEMENT Rare Thickening, fragility, ridging, pitting, atrophy Accompanied by Bone cysts in terminal phalanx Lupus pernio SARCOIDOSIS CLASSIFICATION OF PULMONARY SARCOISOSIS : CLASSIFICATION OF PULMONARY SARCOISOSIS STAGE 0 Initial normal film STAGE 1 Symmetrical hilar adenopathy STAGE 2 Adenopathy with pulmonary opacities SARCOIDOSIS CLASSIFICATION OF PULMONARY SARCOISOSIS : CLASSIFICATION OF PULMONARY SARCOISOSIS STAGE 3 Pulmonary opacities without hilar adenopathy STAGE 4 Pulmonary fibrosis SARCOIDOSIS EYE INVOLVEMENT : EYE INVOLVEMENT Uveitis Conjunctivitis Lacrimal gland involvement Heerfordt’s syndrome Uveitis Parotid gland enlargement Cranial nerve palsies SARCOIDOSIS LIVER AND SPLEEN INVOLVEMENT : LIVER AND SPLEEN INVOLVEMENT Granulomatous infiltration Hepatosplenomegaly SARCOIDOSIS NERVOUS SYSTEM INVOLVEMENT : NERVOUS SYSTEM INVOLVEMENT Aseptic Meningitis Space occupying lesion Cranial neuropathy Peripheral neuropathy SARCOIDOSIS NERVOUS SYSTEM INVOLVEMENT : SARCOIDOSIS NERVOUS SYSTEM INVOLVEMENT MUSCULOSKELETAL SYSTEM : MUSCULOSKELETAL SYSTEM Bone cysts Nodules in muscles SARCOIDOSIS INVESTIGATIONS : INVESTIGATIONS Radiology Kveim skin test Histopathology Biochemistry S. calcium Gamma globulins Monitor disease activity ACE level Radioactive gallium-67 uptake SARCOIDOSIS DIAGNOSIS : DIAGNOSIS SARCOIDOSIS TREATMENT : TREATMENT TOPICAL THERAPY High-potency topical corticosteroids Intralesional triamcinolone Tacrolimus PUVA in hypopigmentation Cosmetic camouflage in lupus pernio SARCOIDOSIS TREATMENT : TREATMENT SYSTEMIC THERAPY Corticosteroids Prednisolone daily 40 mg Maintenance 15 mg alternate Methotrexate Chlorambucil Azathioprine PULSED-DYE LASER Lupus pernio UVA1 (340–440 NM) Plaque sarcoid SARCOIDOSIS PROGNOSIS : PROGNOSIS Better Females Less severe pulmonary disease Positive tuberculin test Normal globulin levels HLA-B8 Mortality 3–6% Cause of death Renal involvement Pulmonary disease SARCOIDOSIS Slide 53: THANK YOU You do not have the permission to view this presentation. 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