Disseminated small-node cutaneous sarcoidosis

For 6 months before admission an 83-year-old woman had experienced itching from papules on her back. Despite local and systemic corticosteroid treatment the lesions had spread further over the back and also began to involve the proximal limbs. On examination the patient was noted to be fit for her age. At the described sites there were scattered red-brown maculopapular lesions, pin-head sized, some circumscribed, others confluent. Diascopy demonstrated them to be greyish yellow. Erythrocyte sedimentation rate was 15/42 mm, serum concentrations of angiotensin converting enzyme (ACE) and calcium were within normal limits. The Tine test was negative. Skin biopsy revealed a granulomatous epithelioid cell inflammation in the corium without central necrosis. She had diabetic retinopathy, a complication of type II diabetes mellitus for many years, and hepatic steatosis. The results of the clinical and histological findings and exclusion of systemic involvement established the diagnosis of disseminated small node cutaneous sarcoidosis. Under clofazimine (Lampren), at an initial dosage of 3 x 100 mg daily by mouth, gradually reduced over 4 months, the cutaneous lesions healed completely and lastingly. This form of sarcoidosis has a good prognosis. Clofazimine, being efficacious and well tolerated, provides a good therapeutic alternative.