Periocular cutaneous sarcoid: Case series
What:
Paper Presentation | Présentation d'article
Part of:
When:
4:11 PM, Friday 1 Jun 2018
(6 minutes)
Where:
Metro Toronto Convention Centre (South Building)
- Room 714 A
How:
Authors: Rehan Rajput, Soupramanien Sandramouli, Hardeep Mudhar, Rina Bhatt
Author Disclosure Block: R. Rajput: None. S. Sandramouli: None. H. Mudhar: None. R. Bhatt: None.
Abstract Body:
Purpose: Periocular sarcoidosis is an uncommon cutaneous manifestation. We aim to highlight the importance of such a rare presentation along with our experience in the management of such lesions in a cohort of four interesting patients.
Study Design: Retrospective case series review of all patients diagnosed with periocular cutaneous sarcoidosis following incisional biopsy and systemic investigation presenting to our adnexal service in the UK, over a 12 month period.
Methods: Four patients presented to our oculoplastic service with periocular cutaneous lesions and underwent incisional biopsy. Following an established diagnosis of cutaneous sarcoidosis, two patients underwent treatment with intralesional triamcinolone, one patient was started on methotrexate therapy and the remaining two patients were observed.
Results: The cohort comprised of 3 males and 1 female. Patient 1 was a 57-year-old Afro-Caribbean gentleman with right upper lid spindle shaped fullness of purple hue and a dough like consistency on palpation. Patient 2 was a 61-year-old Caucasian gentleman with a localized area of scaly dermatitis with a subsequent diagnosis of pulmonary sarcoidosis. Patient 3 was a 47-year-old Caucasian female referred as suspected basal cell carcinoma with a right inner canthal nodular lesion, with a subsequent diagnosis of pulmonary sarcoidosis. Patient 4 was a 56-year-old Caucasian male with bilateral swelling of the medial aspect of his upper lids with subsequent pulmonary involvement on chest CT. Systemic work up in patient 1 did not reveal any extracutaneous sarcoidosis. All patients underwent diagnostic incisional biopsy demonstrating features consistent with cutaneous sarcoidosis. Patients 1 and 3 were treated with intralesional triamcinolone. Patient 1 required further treatment with immunosuppressive therapy under dermatology to avoid side effects of hypopigmentation and ptosis from further triamcinolone. Patients 2 and 4 were observed.
Conclusions: To the best of our knowledge this is the first reported case series of periocular cutaneous sarcoidosis demonstrating the varying morphology of these lesions. The authors highlight both the difficulty in recognising these lesions that show considerable clinical heterogeneity and can mimic other cutaneous pathology. In summary, we have found that over 12 months, sarcoid lesions of the eyelid may remain stable without therapy, can be observed and may respond to intralesional triamcinolone with risk of recurrence. Given the anatomical nature of the eyelids some patients may require systemic immunosuppression and in our experience oral methotrexate at 15 mg/week shows good efficacy with resolution of lesion at 6 months.
Author Disclosure Block: R. Rajput: None. S. Sandramouli: None. H. Mudhar: None. R. Bhatt: None.
Abstract Body:
Purpose: Periocular sarcoidosis is an uncommon cutaneous manifestation. We aim to highlight the importance of such a rare presentation along with our experience in the management of such lesions in a cohort of four interesting patients.
Study Design: Retrospective case series review of all patients diagnosed with periocular cutaneous sarcoidosis following incisional biopsy and systemic investigation presenting to our adnexal service in the UK, over a 12 month period.
Methods: Four patients presented to our oculoplastic service with periocular cutaneous lesions and underwent incisional biopsy. Following an established diagnosis of cutaneous sarcoidosis, two patients underwent treatment with intralesional triamcinolone, one patient was started on methotrexate therapy and the remaining two patients were observed.
Results: The cohort comprised of 3 males and 1 female. Patient 1 was a 57-year-old Afro-Caribbean gentleman with right upper lid spindle shaped fullness of purple hue and a dough like consistency on palpation. Patient 2 was a 61-year-old Caucasian gentleman with a localized area of scaly dermatitis with a subsequent diagnosis of pulmonary sarcoidosis. Patient 3 was a 47-year-old Caucasian female referred as suspected basal cell carcinoma with a right inner canthal nodular lesion, with a subsequent diagnosis of pulmonary sarcoidosis. Patient 4 was a 56-year-old Caucasian male with bilateral swelling of the medial aspect of his upper lids with subsequent pulmonary involvement on chest CT. Systemic work up in patient 1 did not reveal any extracutaneous sarcoidosis. All patients underwent diagnostic incisional biopsy demonstrating features consistent with cutaneous sarcoidosis. Patients 1 and 3 were treated with intralesional triamcinolone. Patient 1 required further treatment with immunosuppressive therapy under dermatology to avoid side effects of hypopigmentation and ptosis from further triamcinolone. Patients 2 and 4 were observed.
Conclusions: To the best of our knowledge this is the first reported case series of periocular cutaneous sarcoidosis demonstrating the varying morphology of these lesions. The authors highlight both the difficulty in recognising these lesions that show considerable clinical heterogeneity and can mimic other cutaneous pathology. In summary, we have found that over 12 months, sarcoid lesions of the eyelid may remain stable without therapy, can be observed and may respond to intralesional triamcinolone with risk of recurrence. Given the anatomical nature of the eyelids some patients may require systemic immunosuppression and in our experience oral methotrexate at 15 mg/week shows good efficacy with resolution of lesion at 6 months.
