clobetasol and Sarcoidosis

Topics: Antibodies, Monoclonal; Antineoplastic Agents; Biopsy; Choroid Neoplasms; Clobetasol; Female; Glucocorticoids; Humans; Ipilimumab; Melanoma; Middle Aged; Sarcoidosis; Skin; Skin Diseases; Treatment Outcome

Sarcoidosis is a multisystem disease characterized by non-caseating granulomas present in the involved organ systems. The disease is believed to result from an interaction among genetic factors, antigens, and the immune response. Environmental exposures and infectious agents have been implicated as potential causes. Cutaneous sarcoidosis presents clinically in many forms and the lesions are classified as either specific or non-specific. Non-specific lesions show a nondescript inflammatory process whereas specific lesions display typical, non-caseating granulomas. There are many different forms of specific lesions with some being more common than others. Psoriasiform lesions are uncommon. The literature suggests that as few as 0.9% of patients display this type of cutaneous sarcoidosis. Some of these patients present solely with cutaneous sarcoidosis, but others have systemic involvement with pulmonary involvement being the most common concomitant presentation. Plaques appear as round or oval, brownish, red infiltrated lesions, frequently involving the extensor surface of the extremities, face, scalp, back, and buttocks. Multiple configurations, including discrete, confluent, annular, and polycyclic, have been reported. Despite the clinical resemblance to psoriasis, on histological examination, only non-caseating granulomas are seen in the dermis. In rare cases both psoriasiform sarcoidosis and psoriasis were present.

Topics: Administration, Cutaneous; Clobetasol; Dermatologic Agents; Diagnosis, Differential; Drug Therapy, Combination; Female; Glucocorticoids; Humans; Infliximab; Middle Aged; Psoriasis; Rituximab; Sarcoidosis; Skin Diseases

Cutaneous sarcoidosis is challenging to diagnose due to its many nonspecific manifestations. In this report we describe a case of cutaneous sarcoidosis in a patient presenting with multiple lesions. Diagnosis of the disease involves not only clinical and pathologic findings but also multiple exclusions.

Topics: Anti-Inflammatory Agents; Black or African American; Clobetasol; Desonide; Female; Glucocorticoids; Humans; Middle Aged; Sarcoidosis; Skin Diseases; United States

Sarcoidosis is an inflammatory granulomatous systemic disease that rarely affects the oral cavity. Gingival involvement has been reported in only a very limited number of cases, occasionally as the first manifestation of the disease. This article reports a case of sarcoidosis affecting the gingiva and alveolar mucosa in a patient previously treated for the systemic disease and considered under long-term clinical control.. A 57-year-old white female presented with a chief complaint of gingival pain in the maxillary right area lasting 3 years. Clinical examination revealed an erythematous, ill-defined erosive macule on the buccal aspect of the maxillary right gingiva extending from the canine to the third molar. The medical history included a diagnosis of sarcoidosis 16 years prior to presentation, which was considered to be under clinical control for the last 11 years. An incisional biopsy was obtained.. Histopathology indicated the presence of an intense chronic inflammatory infiltrate and focal areas with non-caseating granulomas. Periodic acid-Schiff and Grocott's stains were negative for microorganisms, and the diagnosis was compatible with sarcoidosis. Systemic evaluation showed no involvement of other areas and organs, and the patient was managed with topical steroid therapy using silicone trays in conjunction with conventional periodontal therapy and oral hygiene instructions. Complete response was achieved after 6 months, and the patient remains in clinical follow-up.. Although sarcoidosis is a systemic disease that rarely affects the gingiva, the possibility of gingival involvement as the sole manifestation of the disease should be considered in the differential diagnosis of gingival lesions.

Topics: Administration, Topical; Clobetasol; Diagnosis, Differential; Erythema; Female; Gingival Diseases; Glucocorticoids; Humans; Middle Aged; Mouth Mucosa; Oral Ulcer; Sarcoidosis

Topics: Biopsy, Needle; Clobetasol; Female; Follow-Up Studies; Humans; Immunohistochemistry; Middle Aged; Risk Assessment; Sarcoidosis; Sarcoidosis, Pulmonary; Severity of Illness Index; Tomography, X-Ray Computed; Treatment Outcome; Vulvar Diseases

A 45-year-old woman was referred to the dermatology clinic for assessment of "refractory onychogryphosis." She had a 3-year history of lesions involving distal phalanges of the first and third of her left foot. Initially she described periungual erythema and swelling. Three weeks later she noted a whitish growth and thickening of her third toenail. X-ray films of the digit were reported as normal. Several months later the same changes occurred in her great toe. These lesions were asymptomatic. There was no history of trauma. Numerous fungal cultures were negative. No light microscopic examinations were undertaken. She had a trial of both topical and systemic terbinafine of 3-months duration with no clinical improvement. Several clinical opinions were obtained from two dermatologists, a surgeon, and a chiropodist. Past medical history of note was significant for tubal ligation, cervical cancer, and chronic sinusitis. The latter condition in retrospect was thought to be secondary to sarcoidosis. Physical examination revealed periungual violaceous discolouration of the first and third toes of the left foot. There was evidence of significant nail changes including dystrophy, onycholysis, and hyperkeratosis (Fig. 1). The fingernails were normal. There were no other skin abnormalities. A punch biopsy of the tip of the third toe showed granulomatous inflammation. There was evidence of hyperkeratosis, exocytosis, and a dense infiltrate composed of collections of histiocytes and a few giant cells forming granulomas (Fig. 2). Repeat x-ray films of the foot showed soft tissue swelling of the first and third digits. There was bony resorption in the distal phalanges with a lacey trabecular pattern compatible with sarcoidosis (Fig. 3). Chest x-ray films revealed marked hilar adenopathy. The patient was sent to a respirologist who concurred with the diagnosis of sarcoidosis. Further investigations included a low serum calcium of 2.07 mmol/L, serum ACE of 70 U/L (upper limit of normal is 75), Wintrobe erythrocyte sedimentation rate (ESR) of 10 mm per hour, thyroid stimulating hormone concentration of 0.65 mU/L, and a urinary calcium excretion rate that was elevated at 7.3 mmol/day. Pulmonary function tests were unremarkable. The patient was initially treated with clobetasol under occlusion and intralesional triamcinolone with minimal improvement. She was subsequently started on prednisone, 15 mg per os daily because of the lung and bone involvement with significant impro

Topics: Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Diagnosis, Differential; Female; Glucocorticoids; Humans; Middle Aged; Nail Diseases; Nails, Malformed; Prednisone; Radiography; Sarcoidosis; Toes; Triamcinolone

The authors describe an 11-year-old boy who had persistent oral lesions that clinically mimicked first-episode herpetic stomatitis. A biopsy revealed noncaseating sterile granulomas. Investigation of the small and large bowels revealed that the child had Crohn's disease. The oral lesions responded favorably to topical steroid therapy. The authors also discuss the range of oral lesions in inflammatory bowel disease and the differential diagnoses.

Topics: Administration, Topical; Anti-Inflammatory Agents; Child; Chronic Disease; Clobetasol; Crohn Disease; Diagnosis, Differential; Glucocorticoids; Humans; Male; Oral Ulcer; Sarcoidosis; Stomatitis

Topics: Administration, Cutaneous; Adult; Clobetasol; Eyelid Diseases; Facial Dermatoses; Female; Humans; Nose Diseases; Sarcoidosis; Skin Diseases

Topics: Administration, Topical; Adult; Clobetasol; Female; Gingival Hypertrophy; Humans; Sarcoidosis; Skin Diseases