What is it?
Sarcoidosis is a disorder of the immune system. This causes an inflammatory response that causes clustering of inflammatory cells, called granulomas. These granulomas can occur in the whole human body and can affect every organ. They can cause damage and scarring of tissues. How the disease is caused is still unknown. We think that it is because of an exagerated immune response to unknown stimulants in patients who are vulnerable. These granulomas can affect every organ system, but mostly the lungs and the lymph nodes. Involvement of the skin occurs in approximately 1 in 5 patients with sarcoidosis. Various skin abnormalities can occur, but most frequently papules (a pimple) and nodules (lumps). Most characteristic abnormality are papules around the nose. Erythema nodosum also occurs. This a local inflammation of the fatty tissue under the skin, most frequently localised on the shins.
How do I know I have it?
In most cases ancillary investigations have to be performed to diagnose a patient with sarcoidosis and to exclude other possible diagnoses. This includes laboratory investigations, but also imaging study to evaluate involvement of other organs than the skin. To diagnose a patient with 100% certainty, you can evaluate the presence of granulomas in affected tissue, the so-called biopsy. In patients with skin involvement a biopsy of the skin abnormalities can be done. When the presence of granulomas is confirmed by looking at the tissue under the microscope the diagnosis is certain. On the top of this webpage in blue you can see an example of granulomas under the microscope.
Can it be treated?
A treatment for skin involvement in sarcoidosis patients is not always necessary. With this manifestation you doctor can choose to treat the skin abnormalities locally. This means that a corticosteroid containing salve can be applied on the skin abnormalities. Corticosteroids are hormones that lower the immune response. Depending on the severity and the extent of the skin involvement and/or involvement of other organs, your doctor can choose to give corticosteroids in tablets (prednisolone), via an injection in the skin abnormality or via an intravenous drip. Corticosteroids act quickly. While sometimes a combination of the aforementioned options is necessary to suppress the disease efficiently, in other situations only treatment with a corticosteroid containing salve is necessary. When the disease is severe, or when prolonged treatment with corticosteroids is necessary, a second type of medication can be added that acts on the immune system differently, like methotrexate or azathioprine. These are agents that are also being used in other disorders of the immunesystem, for example rheumatoid arthritis. When sarcoidosis proves difficult to treat despite aforementioned medication, your doctors can choose to treat you with specific powerfull antibodies, like infliximab.
We are a tertiary referral center for patients with sarcoidosis. Healthcare for patients with sarcoidosis can be complex. Our opinion is that because the disease is relatively rare, care for these patients with severe manifestations of the disease should be performed preferably in a few specialised hospitals. We want to improve Healthcare for these patients. Part of this is a specialist outpatient clinic for sarcoidosis patients with a multidisciplinary approach. Additionally we have started various scientific researchprojects, aimed at improving the diagnostic process and treatment of this disease. Below you can find more information concerning the dermatology department, who we are, what kind of research we are conducting and how you can refer patients to us.