tacrolimus and Sarcoidosis

The disseminated cutaneous granulomatosis (DCG) are heterogeneous cutaneous diseases histologically characterized by a granulomatous infiltrate. The most frequent cutaneous granulomatosis is sarcoidosis, but many other causes can be found, because DCG are probably a skin granulomatous reaction to different stimuli: infectious, inflammatory, neoplastic, metabolic or chemical. The histopathological examination is useful for the diagnosis of DCG, but gives rarely an etiological diagnosis. In this article, we will propose a strategy for the etiological diagnosis of DCG, and propose therapeutic recommendations based on recent data from the literature.

Topics: Administration, Cutaneous; Biopsy; Dermatologic Agents; Drug Therapy, Combination; Granuloma Annulare; Granulomatous Disease, Chronic; Humans; Immunosuppressive Agents; Phototherapy; Practice Guidelines as Topic; Retinoids; Sarcoidosis; Skin Diseases; Tacrolimus; Treatment Outcome; Tumor Necrosis Factor-alpha

Topics: Cheek; Female; Hepatic Duct, Common; Humans; Keratosis; Lymph Nodes; Lymphadenopathy; Middle Aged; Sarcoidosis; Skin; Tacrolimus; Thalidomide; Tomography, X-Ray Computed

Topics: Aged; Calcineurin Inhibitors; Facial Dermatoses; Female; Humans; Sarcoidosis; Tacrolimus

Topics: Aged; Biopsy; Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Sarcoidosis; Tacrolimus; Treatment Outcome

We report a case of lichenoid sarcoidosis in a young girl treated by oral tacrolimus and methylprednisolone. The patient had had a skin eruption from 1 year of age and had developed uveitis at 2 years of age. Her sight had become affected by the uveitis at 8 years of age. When she was 14, she was admitted to the ophthalmology department of our hospital to start treatment with tacrolimus (FK506). She was referred to the department of dermatology for her skin lesions, which were flat, pinkish or normal skin-colored papules scattered on her extremities and the backs of her hands. Upon histology, epithelioid granulomas were seen in the upper dermis and around the erector pili muscles. She received tacrolimus (FK506) 6 mg/day for 3 months for her uveitis. The eye lesions subsided somewhat, and the skin lesions were almost healed after the 3-month course of tacrolimus. However, 4 months after stopping the tacrolimus, her skin and eye lesions relapsed. At that point, she was started on methylprednisolone 16 mg/day for her uveitis. With the methylprednisolone treatment, the inflammation of the eye lesion immediately healed, as did the skin lesions.

Topics: Administration, Oral; Adolescent; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Leg; Methylprednisolone; Sarcoidosis; Skin Diseases; Tacrolimus; Uveitis

Sarcoidosis is a granulomatous disease of unknown etiology and is only rarely seen in infants and children. We present the case of a 9-year-old boy who developed sarcoidosis with multi-organ involvement 9 years after cardiac transplantation for Shone complex. The patient was on immunosuppressive therapy with tacrolimus and mycophenolate mofetil. He presented with severe respiratory distress due to marked mediastinal lymphadenopathy and bilateral pulmonary infiltrates in association with fatigue, low-grade fever, hepatosplenomegaly and generalized lymphadenopathy. Lymph node histology showed non-caseating epitheloid cell granulomas and giant cells. Initialization of therapy with prednisolone resulted in prompt clinical recovery and resolution of all symptoms except for the development of mild pulmonary fibrosis. Tapering of the steroids led to recurrence of mediastinal lymphadenopathy 5 months after the initial disease, which responded to an increase in steroid dose. The clinical course, the medical management, and the possible role of immunosuppression in the etiology of the disease are discussed.

Topics: Child; Dose-Response Relationship, Drug; Glucocorticoids; Heart Transplantation; Humans; Immunosuppressive Agents; Lymph Nodes; Male; Mycophenolic Acid; Postoperative Complications; Prednisolone; Radiography, Thoracic; Recurrence; Retreatment; Sarcoidosis; Tacrolimus; Tomography, X-Ray Computed

Sarcoidosis encompasses a heterogeneous spectrum of clinical presentations, including sarcoidosis in association with tattoos. We report the development of cutaneous and pulmonary sarcoidosis in a patient with long-standing eyebrow tattoos whose cutaneous sarcoidosis almost completely resolved when treated with tacrolimus 0.1% ointment. A 70-year-old woman with a 3-year history of an erythematous eruption circumscribing her eyebrow tattoos presented with a chronic, nonproductive cough of 8 months' duration. Skin biopsy results demonstrated naked tubercles consistent with sarcoidosis. Results of radiographs and a computed tomography scan of the chest revealed multiple pulmonary nodules with mediastinal and hilar adenopathy. The results of transbronchial biopsy were consistent with the diagnosis of pulmonary sarcoidosis. Initial treatment with oral prednisone only improved the pulmonary sarcoidosis. The cutaneous sarcoidosis almost completely resolved after the addition of tacrolimus 0.1% ointment.

Topics: Aged; Female; Glucocorticoids; Humans; Immunosuppressive Agents; Prednisone; Sarcoidosis; Skin Diseases; Tacrolimus; Tattooing

A 56-year old female patient with cutaneous sarcoidosis in the face was treated with fumaric acid esters and doxycycline without any effect. Topical tacrolimus led clinically and histologically to a nearly complete remission within three months, which continued after 4 months of follow-up.

Topics: Biopsy; Female; Follow-Up Studies; Humans; Immunosuppressive Agents; Middle Aged; Ointments; Sarcoidosis; Skin; Skin Diseases; Tacrolimus; Time Factors

Sarcoidosis is a disorder characterized by macrophage- and T-cell-mediated responses to as yet unidentified infectious antigens or autoantigens. We describe a 62-year-old woman with a 10-year history of orange-yellow plaques of sarcoidosis on her face. Her cutaneous lesions responded to topical tacrolimus ointment after unsuccessful treatment with topical and systemic corticosteroids. No adverse effects were noted with topical tacrolimus in this patient. We discuss the mode of action by which this immunosuppressive agent may act against sarcoidosis.

Topics: Facial Dermatoses; Female; Humans; Immunosuppressive Agents; Middle Aged; Sarcoidosis; Tacrolimus