Permanent Makeup Procedure Heralds the Development of Systemic Sarcoidosis

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Abstract

Permanent cosmetic procedures including tattooing are determined as risk factors that prompt the development of cutaneous granulomatous conditions. Scar sarcoidosis is an uncommon manifestation of a systemic granulomatous disease with a few cases reported in the literature worldwide. Although the incidence rates of sarcoid lesions at sites of pigment deposition are low, granuloma formation can provoke a severe systemic inflammatory response. We report a 48-year-old Hispanic female with a new onset of scar sarcoidosis that progressed to a systemic condition. Erythematous maculopapular eruptions arose on her left eyebrow area at the sites of scars from cosmetic tattooing, prior to exacerbation of the small airway disease. Histopathologic examination revealed typical findings of cutaneous sarcoidosis, including non-caseating epithelioid granulomas. This case highlights the importance of early detection of cutaneous sarcoidosis in long-standing scars due to the associated risks of systemic sarcoidosis.

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Histopathologic review of granulomatous inflammation

Kabeer Shah, Bobbi Pritt, Mariam P. Alexander (2017)

Granulomatous inflammation is a histologic pattern of tissue reaction which appears following cell injury. Granulomatous inflammation is caused by a variety of conditions including infection, autoimmune, toxic, allergic, drug, and neoplastic conditions. The tissue reaction pattern narrows the pathologic and clinical differential diagnosis and subsequent clinical management. Common reaction patterns include necrotizing granulomas, non necrotizing granulomas, suppurative granulomas, diffuse granulomatous inflammation, and foreign body giant cell reaction. Prototypical examples of necrotizing granulomas are seen with mycobacterial infections and non-necrotizing granulomas with sarcoidosis. However, broad differential diagnoses exist within each category. Using a pattern based algorithmic approach, identification of the etiology becomes apparent when taken with clinical context. The pulmonary system is one of the most commonly affected sites to encounter granulomatous inflammation. Infectious causes of granuloma are most prevalent with mycobacteria and dimorphic fungi leading the differential diagnoses. Unlike the lung, skin can be affected by several routes, including direct inoculation, endogenous sources, and hematogenous spread. This broad basis of involvement introduces a variety of infectious agents, which can present as necrotizing or non-necrotizing granulomatous inflammation. Non-infectious etiologies require a thorough clinicopathologic review to narrow the scope of the pathogenesis which include: foreign body reaction, autoimmune, neoplastic, and drug related etiologies. Granulomatous inflammation of the kidney, often referred to as granulomatous interstitial nephritis (GIN) is unlike organ systems such as the skin or lungs. The differential diagnosis of GIN is more frequently due to drugs and sarcoidosis as compared to infections (fungal and mycobacterial). Herein we discuss the pathogenesis and histologic patterns seen in a variety of organ systems and clinical conditions.

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Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis

Patompong Ungprasert, Jay H Ryu, Eric L Matteson (2019)

The focus of this review is current knowledge about the epidemiology, clinical manifestations, diagnosis, and treatment of both pulmonary sarcoidosis and extrapulmonary sarcoidosis. Although intrathoracic involvement is the hallmark of the disease, present in over 90% of patients, sarcoidosis can affect virtually any organ. Clinical presentations of sarcoidosis are diverse, ranging from asymptomatic, incidental findings to organ failure. Diagnosis requires the presence of noncaseating granuloma and compatible presentations after exclusion of other identifiable causes. Spontaneous remission is frequent, so treatment is not always indicated unless the disease is symptomatic or causes progressive organ damage/dysfunction. Glucocorticoids are the cornerstone of treatment of sarcoidosis even though evidence from randomized controlled studies is lacking. Glucocorticoid-sparing agents and biologic agents are often used as second- and third-line therapy for patients who do not respond to glucocorticoids or experience serious adverse effects.

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Erythema nodosum: a sign of systemic disease.

Allison R. Schwartz, Stephen Nervi (2007)

Erythema nodosum, a painful disorder of the subcutaneous fat, is the most common type of panniculitis. Generally, it is idiopathic, although the most common identifiable cause is streptococcal pharyngitis. Erythema nodosum may be the first sign of a systemic disease such as tuberculosis, bacterial or deep fungal infection, sarcoidosis, inflammatory bowel disease, or cancer. Certain drugs, including oral contraceptives and some antibiotics, also may be etiologic. The hallmark of erythema nodosum is tender, erythematous, subcutaneous nodules that typically are located symmetrically on the anterior surface of the lower extremities. Erythema nodosum does not ulcerate and usually resolves without atrophy or scarring. Most direct and indirect evidence supports the involvement of a type IV delayed hypersensitivity response to numerous antigens. A deep incisional or excisional biopsy specimen should be obtained for adequate visualization. Erythema nodosum represents an inflammatory process involving the septa between subcutaneous fat lobules, with an absence of vasculitis and the presence of radial granulomas. Diagnostic evaluation after comprehensive history and physical examination includes complete blood count with differential; erythrocyte sedimentation rate, C-reactive protein level, or both; testing for streptococcal infection (i.e., throat culture, rapid antigen test, antistreptoly-sin-O titer, and polymerase chain reaction assay); and biopsy. Patients should be stratified by risk for tuberculosis. Further evaluation (e.g., purified protein derivative test, chest radiography, stool cultures) varies based on the individual. Erythema nodosum tends to be self-limited. Any underlying disorders should be treated and supportive care provided. Pain can be managed with nonsteroidal anti-inflammatory drugs.

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Author and article information

Journal

Journal ID (nlm-ta): Cureus

Journal ID (iso-abbrev): Cureus

Journal ID (issn): 2168-8184

Title: Cureus

Publisher: Cureus (Palo Alto (CA) )

ISSN (Electronic): 2168-8184

Publication date (Electronic, pub): 31 October 2022

Publication date (Electronic, collection): October 2022

Volume: 14

Issue: 10

Electronic Location Identifier: e30918

Affiliations

[1 ] Osteopathic Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Clearwater, USA

[2 ] Dermatology, ADF Dermatology and Skin Surgical Center of Sarasota, Sarasota, USA

[3 ] Dermatology, Michigan State University College of Osteopathic Medicine, East Lansing, USA

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Alena Bashinskaya alenabashin@ 123456gmail.com

Article

DOI: 10.7759/cureus.30918

PMC ID: 9710721

SO-VID: d0fdd1b3-0dd2-4bd3-8b55-7b5af89ffdcd

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This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Date accepted : 31 October 2022

Permanent Makeup Procedure Heralds the Development of Systemic Sarcoidosis

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Most cited references 20

Histopathologic review of granulomatous inflammation

Clinical Manifestations, Diagnosis, and Treatment of Sarcoidosis

Erythema nodosum: a sign of systemic disease.

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