From the Guidelines
The cause of cutaneous sarcoidosis is not definitively linked to mold exposure. Sarcoidosis is a multisystem inflammatory disorder characterized by non-caseating granulomas, and its exact cause remains unknown 1. While environmental factors have been proposed as potential triggers, including infectious agents, inorganic particles, and certain exposures, there is insufficient scientific evidence specifically connecting mold exposure to the development of cutaneous sarcoidosis. The disease is thought to result from an abnormal immune response in genetically susceptible individuals, with various potential environmental triggers rather than a single cause.
Some key points to consider in the management of cutaneous sarcoidosis include:
- Treatment typically involves corticosteroids like prednisone (starting at 20-40mg daily with gradual tapering), antimalarials such as hydroxychloroquine (200mg twice daily), methotrexate (10-25mg weekly), or TNF-alpha inhibitors for severe cases 1.
- Patients with cutaneous sarcoidosis should be evaluated for systemic involvement, particularly pulmonary, as skin manifestations often accompany involvement of other organs.
- If you suspect sarcoidosis, consultation with dermatology and possibly pulmonology is recommended for proper diagnosis and management.
- The Sarcoidosis Activity and Severity Index (SASI) provides a scale of different aspects of skin disease including erythema, induration and desquamation, and can be used to assess response to treatment 1.
Overall, the management of cutaneous sarcoidosis should prioritize reducing morbidity, mortality, and improving quality of life, with a focus on treating cosmetically important lesions and managing systemic involvement.
From the Research
Cutaneous Sarcoidosis and Mold Exposure
- There is no direct evidence in the provided studies to suggest that mold exposure causes cutaneous sarcoidosis 2, 3, 4, 5, 6.
- The etiology of sarcoidosis, including cutaneous sarcoidosis, is unknown, and it is characterized by the presence of non-caseating granulomas 2, 5.
- Cutaneous manifestations of sarcoidosis can be highly variable and may be "specific" or "nonspecific" reactive inflammatory processes 5.
- Treatment approaches for cutaneous sarcoidosis include corticosteroids, antimalarials, methotrexate, and biologics, but the role of these treatments is not well-defined, and larger studies are needed to assess their efficacy and adverse effects 2, 3, 4, 6.
Current Understanding of Cutaneous Sarcoidosis
- Cutaneous sarcoidosis is a multisystem inflammatory disorder that affects approximately 20% to 30% of patients with sarcoidosis 4, 6.
- The skin is often the second most frequently involved organ in sarcoidosis, and cutaneous manifestations can be the initial presenting sign or develop later in the course of the disease 5.
- Dermatologic evaluation may be helpful for establishing a definitive diagnosis of cutaneous sarcoidosis, and treatment strategy depends on the severity and distribution of skin lesions 6.