From the Guidelines
Facial sarcoidosis should be treated with topical corticosteroids, such as clobetasol 0.05% cream, or intralesional triamcinolone injections for isolated lesions, with consideration of oral medications like prednisone, hydroxychloroquine, or methotrexate for more extensive involvement, as guided by the impact of disfigurement and other organ involvement 1.
Treatment Considerations
When managing facial sarcoidosis, it's crucial to consider the cosmetic and psychological impact of the disease, as well as the potential for systemic involvement, particularly affecting the lungs. The Sarcoidosis Activity and Severity Index (SASI) can be a useful tool in assessing the response to treatment 1.
Therapeutic Approach
Treatment decisions are often guided by the extent of disfigurement and the presence of other organ involvement, taking into account comorbidities that may increase the risk of drug toxicity 1. For instance:
- Topical corticosteroids can be effective for localized lesions.
- Intralesional injections may be considered for isolated lesions.
- Oral medications such as prednisone, hydroxychloroquine, or methotrexate may be necessary for more extensive disease.
Management and Follow-Up
Regular follow-up with both dermatology and pulmonology specialists is essential, given the potential for systemic disease. Patients should also be advised on protecting the affected skin from sun exposure, as UV radiation can exacerbate symptoms. The goal of treatment is not only to manage the symptoms but also to improve the quality of life for patients with facial sarcoidosis, considering the potential psychological distress associated with cosmetic concerns.
From the Research
Sarcoidosis and its Effects on the Face
- Sarcoidosis is a multisystemic, granulomatous disease that can affect various organs, including the skin 2.
- Skin lesions are among the most frequent extrapulmonary manifestations of sarcoidosis, with a prevalence of 25-50% 3.
- Facial involvement in sarcoidosis can include skin lesions, such as lupus pernio, which is a specific type of skin lesion that is highly suggestive of sarcoidosis 3.
- Other facial manifestations of sarcoidosis can include nasosinusal or laryngeal signs, which can be the initial manifestation of the disease 3.
Treatment of Sarcoidosis
- Corticosteroids are the primary treatment for sarcoidosis, including facial manifestations 4, 5.
- However, due to the potential toxicities of corticosteroids, alternative medications, such as steroid-sparing agents, may be considered 6, 5.
- The choice of treatment depends on the severity of symptoms, the extent of organ involvement, and the patient's response to treatment 5.
Diagnosis of Sarcoidosis
- The diagnosis of sarcoidosis is based on a combination of clinical, radiological, and histological findings 3.
- A compatible clinical and/or radiological presentation, histological evidence of non-necrotizing granulomatous inflammation, and the exclusion of alternative causes of granulomatous disease are the major criteria for diagnosis 3.
- Certain clinical features, such as Löfgren's syndrome, lupus pernio, and Heerfordt's syndrome, are highly specific for sarcoidosis and do not require histological confirmation 3.