Abstract
Sarcoidosis is a granulomatous condition that has a highly variable presentation. One rare presentation of sarcoidosis is cutaneous scalp sarcoidosis. Usually scalp sarcoid presents as a scarring alopecia, but it can be nonscarring. The presence of sarcoidal lesions on the scalp is associated with systemic disease, as are other cutaneous manifestations of sarcoidosis. The authors present the case of a 64-year-old woman with a history of sarcoidosis who presented with alopecia and hypopigmented patches on her scalp. She also had papular sarcoid lesions on her upper back and a history of pulmonary involvement, which is consistent with previous reports in the literature. The condition subsequently improved with topical clobetasol propionate.
Sarcoidosis is a disease characterized by a wide array of cutaneous and extracutaneous clinical presentations with distinctive histopathologic findings of noncaseating epithelioid granulomas, also called
naked granulomas because of a sparse lymphocytic infiltrate surrounding the granuloma.
1 Sarcoidosis has been reported to affect all body systems, but it has a predilection for the lungs, lymphatic system, and skin. The disease most commonly presents in black women aged 20 to 80 years. Approximately 20% of patients with sarcoidosis have cutaneous lesions.
2 These lesions can be divided into specific and nonspecific types. Specific lesions have the characteristic histopathologic findings associated with the disease but can vary widely in clinical morphology and location. Papular sarcoidosis is the most common cutaneous presentation, marked by numerous nonscaled papules often located on the nasolabial folds and eyelids, but it can also involve other areas, such as the upper back.
2,3 Scalp sarcoidosis, although rare, presents with important associations that are relevant to diagnosis and treatment, as seen in the following case of a woman with alopecia and rash.