Cutaneous sarcoidosis among Taiwanese

Background and purpose: Sarcoidosis is a multisystem disorder characterized by noncaseating, naked, epithelioid granulomas, and commonly involving the hilar lymph nodes, lungs, skin, and eyes. Once thought to be rare in Chinese, it is being encountered with increasing frequency in Taiwan. In this study, we examined the clinicopathologic findings of sarcoidosis in Chinese patients in Taiwan and investigated the role of Mycobacterium tuberculosis in the disease. Methods: The clinicopathologic features of all patients treated for sarcoidosis at a tertiary care hospital in Tainan during a 10-year period were retrospectively examined. Nested polymerase chain reaction (PCR), using the IS6110 sequence as the amplification target, was used to detect M. tuberculosis complex DNA in formalin-fixed, paraffin-embedded skin specimens. Results: Sarcoidosis was diagnosed in a total of 12 patients (7 men, 5 women; mean age, 53 yr) during the study period. All patients presented with skin lesions varying from erythematous papules or nodules mainly located on the face (8 patients), to widespread papules, large plaques, and tumors on the extremities, trunk, or scalp (4 patients). Seven of the 12 patients had extracutaneous involvement. One developed cutaneous T cell lymphoma after 14 years of severe disease. Histopathologic examination of skin lesions revealed sarcoid or mixed sarcoid/tuberculoid granulomatous infiltration without evidence of mycobacterial, deep fungal infection, or foreign body material. Nested PCR failed to detect M. tuberculosis complex DNA in skin specimens. Conclusions: Our data suggest that sarcoidosis manifests with a wide range of cutaneous lesions in Taiwanese patients and that extracutaneous involvement is not rare. Dermatologists and general practitioners should be made aware that sarcoidosis may first manifest with skin lesions, so that the correct diagnosis can be made promptly. M. tuberculosis did not appear to be associated with sarcoidosis in this study group.