SKIN SARCOIDOSIS – CLINICAL CASE

Sarcoidosis is a chronic multisystem disease from the group of granulomatoses of unknown etiology, the morphological feature of which is the development of epithelioid cell granulomas without caseous necrosis with the processes of dystrophy, destruction, and fibrosis in the tissues of various organs. It commonly involves the lungs, eyes, lymph nodes, and skin. The disease usually begins at around 40 years of age, and nearly two-thirds of the cases involve females. Because lesions assume a vast array of morphologies, cutaneous sarcoidosis is known as one of the “great imitators” in dermatology. The diagnosis and differential diagnosis of sarcoidosis are based on clinical examination, changes in laboratory data, X-ray methods, and a skin biopsy. The differential diagnosis includes many dermatoses, including tuberculoid-type of leprosy, lupus vulgaris, lichen planus, annular granuloma, etc. There are increasingly frequent reports in the literature about the development of immune granulomatous inflammation reactions after numerous cosmetic procedures, such as tattooing, botulinum toxin A injection, hyaluronic acid injections, permanent makeup, bio revitalization, facial modelling fillers, and blepharoplasty. The cause of sarcoidal reaction in a tattoo has been controversial since the first case was described by Madden in 1939. It is still unclear whether it is caused by a local reaction to pigment, a hypersensitivity syndrome to an as yet unidentified component in the tattoo, or a specific manifestation of systemic sarcoidosis. The article describes a case of skin sarcoidosis that began five years later at the site of a tattoo, with further involvement of the intra-thoracic lymph nodes in the pathological process.