PURPOSE: Sarcoidosis is a multi-organ granulomatous disease of unknown cause that most commonly affects the lungs. Approximately 25% of sarcoid patients will also have dermatologic manifestations. From clinical experience, we routinely see patients with multiple concomitant dermatologic manifestations of sarcoidosis (DMOS). We hypothesized that patients with more active dermatologic sarcoidosis (as evident through multiple concomitant DMOS) would also have more severe pulmonary sarcoidosis.
METHODS: Patients were identified by ICD-9 code 135.0 (Sarcoid) who were seen in the Dermatology clinic between 1994 and the present. Inclusion criteria were age ≥ 18 years old, and a diagnosis of dermatologic sarcoidosis confirmed by chart review. Chart reviews were done on 62 dermatology patient charts. Information was collected (from approximately the same date as the skin exam had taken place) on chest radiograph Scadding stage, pulmonary function test data, and demographic data. 51 of the patients had radiographic data. SAS and JMP software (Cary NC) were used for analysis of the data. Wilcoxon rank sum tests were done on numeric data and Fisher's exact tests were performed on ordinal data.
RESULTS: The chart review showed that 24 patients had one DMOS and 38 patients had multiple concomitant DMOS. There was no statistical difference in the two groups in the following areas: radiographic staging (table 1); percent predicted values for spirometry, lung volumes, diffusion limitation of carbon monoxide (table 2); body mass index (table 2), race or sex. 68% (31 patients) of all patients presenting to dermatology clinic with chest radiographs had stage 1 radiographic disease or greater.
CONCLUSION: The increasing number of different DMOS does not correlate with degree of severity of pulmonary involvement. Most of our patients had several DMOS rather than one.
CLINICAL IMPLICATIONS: Our study serves as a reminder that any sarcoid skin lesion should prompt a dermatologist to refer a patient to a general practitioner or pulmonologist for further workup for systemic disease.
DISCLOSURE: Cia Bergh, None.