CORRECT DIAGNOSIS:
Subcutaneous sarcoidosis (aka Darier-Roussy sarcoidosis)
DISCUSSION:
Subcutaneous sarcoidosis (previously referred to as Darier-Roussy sarcoidosis) is an uncommonly diagnosed form of sarcoidosis characterized by non-tender deep 0.5cm to 2.0cm nodules generally noted on the upper extremities (1,2). Clinical diagnosis can prove challenging as it can mimic other chronic diseases or infection including cellulitis and even metastatic breast cancer (3,4).
Histologically, subcutaneous sarcoidosis presents with noncaseating pannicular noninfectious sarcoidal or epithelioid granulomas in the subcutaneous tissue with little lymphocytic infiltrate (1,5).
Of note, subcutaneous sarcoidosis serves as the sole subtype of cutaneous sarcoidosis that is commonly associated with systemic disease (5).
TREATMENT:
Regular appointments for the initial three to 6 months after diagnosis is recommended as spontaneous remissions can occur. Persistent or worsening cases can be treated with glucocorticoids, followed by slow tapering (1). For patients seeking steroid-sparing therapy, hydroxychloroquine may serve as an alternative treatment (6).
REFERENCES:
Bosnić, D., Baresić, M., Bagatin, D., et al. (2010). Subcutaneous sarcoidosis of the face. Internal Medicine, 49(6), 589-592. https://doi.org/10.2169/internalmedicine.49.3543
Haimovic, A., Sanchez, M., Judson, M. A., et al. (2012). Sarcoidosis: A comprehensive review and update for the dermatologist. Part I. Cutaneous disease. Journal of the American Academy of Dermatology, 66(699.e1). https://doi.org/10.1016/j.jaad.2011.11.012
Papadavid, E., Dalamaga, M., Stavrianeas, N., et al. (2008). Subcutaneous sarcoidosis masquerading as cellulitis. Dermatology, 217(3), 212-213. https://doi.org/10.1159/000157839
Viswanath, L., Pallade, S., Krishnamurthy, B., et al. (2009). Darier-Roussy sarcoidosis mimicking metastatic breast cancer. Case Reports in Oncology, 2(3), 251-254. https://doi.org/10.1159/000225154
Ahmed, I., & Harshad, S. R. (2006). Subcutaneous sarcoidosis: Is it a specific subset of cutaneous sarcoidosis frequently associated with systemic disease? Journal of the American Academy of Dermatology, 54(1), 55-60. https://doi.org/10.1016/j.jaad.2005.06.010
Marchetti, M., Baker, M. G., & Noland, M. M. (2014). Treatment of subcutaneous sarcoidosis with hydroxychloroquine: Report of 2 cases. Dermatology Online Journal, 20(1), 21250. PMID: 24618122
