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Posted: Mon Jan 21st, 2008 17:42 |
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Cutaneous manifestations of Th1 inflammation
Cutaneous immunopathology
The body of folks with systemic Th1 infection severe enough to cause sarcoid granuloma is going to exhibit wierd physical phenomena as it heals. These include spots on the skin which are often red. Although these manifestations can be scary but there is nothing we know which can help you get through the 'Herx' phase of this disease any faster than the slow, steady, bacterial killoff of the MP.
Pigmentation
As the skin recovers from inflammation, what may remain is skin that is either darker or lighter in color than normal skin. Either condition is usually temporary but it may take months or even years for skin pigmentation to return to normal.
Post-Inflammatory Hyperpigmentation
Darker skin that develops at the site of inflammation is called hyperpigmentation may remain in the area that was injured or inflamed. The darker skin will have a mottled appearance or indistinct border.
There are two possible causes thought to be responsible for this sort of hyperpigmentation. When the skin looks dirty brown, it is because inflammation and the healing process deranged some of the cells producing melanin to color (pigment) the skin. If the skin is reddish brown, it may be due to deposits of haemosiderin left behind from red blood cells as the skin healed.
Post-inflammatory Hypopigmentation
Lighter skin found in place following healing from inflammation is called hypopigmentation. It develops because the cells that produce melanin have been injured or destroyed in the healing process.
Care of Hyperpigmented or Hypopigmented Skin
Cosmetics may help cover a discoloration. Use moisturizers as needed and avoid sunlight and extreme heat. Consult your physician if you continue to have concerns.
Lupus pernio
Lesions on the face that occur or exacerbate when it's cold or windy can be what is called lupus pernio. Lupus Pernio is a skin manifestation of sarcoidosis. Lupus Pernio is not another disease (and is not related to lupus), it's simply a name for the red-to purplish lesions that can appear on the nose, face, ears or hands of sarcoidosis patients. These lesions can occur when the nose, face or hands are exposed to cold or wind, so it's a good idea for sarcies to keep these areas protected from wind and cold. Avoiding exposure to bright lights is also an important preventative measure.
Lupus pernio, first described by Ernest Besnier, is the most characteristic of all sarcoid lesions. Lupus Pernio is a skin manifestation of sarcoidosis. Lupus Pernio is not another disease (and is not related to lupus), it's simply a name for the red-to purplish lesions that can appear on the nose, face, ears or hands of sarcoidosis patients. These lesions can occur when the nose, face or hands are exposed to cold or wind, so it's a good idea for sarcies to keep these areas protected from wind and cold. Avoiding exposure to bright lights is also an important preventative measure.
Sometimes lupus pernio lesions will have an appearance of small "beads" along their edge, especially if the sore is on the rim of the nose. If left untreated, lupus pernio lesions can be disfiguring and cause a patient to feel embarrassed, particularly since they may be noticeable on facial areas so visible to the public.
Like some other cutaneous sarcoidosis lesions, lupus pernio can appear at sites of old scars or trauma.
Lupus pernio lesions, like other sarcoid manifestations in the upper respiratory tract, can be quite resistant to the standard immunosuppressive therapies.
Lupus pernio is said to be the skin lesion most characteristic (a diagnostic indicator) of sarcoidosis, but not all sarcoidosis patients have these skin lesions.
-My experience with lupus pernio is that it flares with exposure to light plus cold and wind. I suspect you have still been having a good bit of cool wind and weather in your part of the world. You may need to keep your nose better protected. I know that's hard to do, so if nothing else, you can stay indoors during daytime as much as possible and wrap a scarf around your nose if it is cool or windy.
Warning of the risk of scarring, whether on the skin or in the lungs, is a common tactic to pressure patients to use the treatment a physician prefers. Lupus pernio has a reputation for being difficult to treat. In reality, the doctor has no way to know whether you will scar. Certainly I sustained no scars from my winter bouts with lupus pernio. ~Belinda
Skin rash
This article by a practicing dermatologist explains that both "specific" and "non-specific" skin lesions are found in sarcoidosis, explaining, "Specific skin lesions are generally associated with chronic disease and demonstrate noncaseating granulomas in the dermis on histological examination. Nonspecific skin lesions are seen primarily with acute disease and noncaseating granulomas are absent."
Erythema nodosum
Erythema Nodosum is a common manifestation of acute sarcoidosis.
Subcutaneous Nodules
Subcutaneous nodular sarcoid lesions are sometimes called Darier-Roussy sarcoidosis, named for the French physicians Darier and Roussy who described these subcutaneous nodules in 1904.
Skin tags
Here is a photo of skin tags.
According to this source, alternate names for skin tags are:
* Acrochordons
* Papillomas
* Soft fibromas
* Pedunculated (this means they are on a stalk)
* Filiform (this means they are thread-like)
"Skin tags develop in both men and women as they grow older. They are skin coloured or darker and range in size from 1mm to 5cm. They are most often found in the skin folds (neck, armpits, groin). They tend to be more numerous in obese persons and in those with type 2 diabetes mellitus."
Sarcoidosis manifests in a wide variety of skin lesions. You can find links to photos of cutaneous sarcoidosis on this SarcInfo thread. Here is a photo of sarc lesions around the eye.
Lesions
Some of the types of skin lesions encountered in sarcoidosis, and the other diseases these resemble are:
Papules (little bumps) resembling
Granulomatous rosacea
Acne
Benign appendageal tumors
Plaques resembling
Psoriasis
Lichen planus
Nummular eczema
Discoid lupus
erythematosus
Granuloma annulare
Cutaneous T-cell lymphoma
Kaposi's sarcoma
Secondary syphilis
Lupus pernio resembling
Scar
Discoid lupus erythematosus
(more info on lupus pernio can be found in a later post)
Erythema nodosum resembling
Cellulitis
Furunculosis
Other inflammatory panniculitis
Sarcoid skin lesions can be painful, itchy, oozy or dry and peeling. They can also make your hair fall out. You can find more information and lots of pictures of skin sarcoidosis (to compare with your rashes) in the thread "Skin Sarc, What Does it Look Like?" or Images of cutanenous sarcoidosis.
Members' experiences
-Ive been on the MP now for 1 year this month. I have skin lesions on my face and i noticed them get better, texture and inflammation wise, when i started the the first meds, olmersartan and then the first antibiotic. Now texture has greatly improved, lesions were very dry, inflamed and flakey and hurt alot when touched before starting MP. A few months ago i noticed, not only have they impoved in texture but some are actually starting to fade on some sides. I've gotten a few new lesions since starting but there also improving. None have actually completely gone or disappeared but i think now there starting to show signs of great improvement ahead and i feel that from the improvements i have witnessed that they will fade away and leave no marks, some time in the near future. I havent yet reached the the optimal level of all antibiotics yet but hopeful will in November and then stay at that optimal level for the next 12-24 months, so im sure i will see more improvement and disappearance of the lesion. ~sd
Last edited on Thu Oct 23rd, 2008 07:40 by
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