Dermatologist Sees Full Picture of Diagnosis with VisualDx

Aaron W., dermatologist at University of British Columbia, shares how VisualDx helped him check for underlying conditions that could impact his patient’s care and treatment.

“My patient was a 58-year-old male with cutaneous sarcoid lesions referred by respirology. Sarcoidosis diagnosed via chest x-ray many years ago. The lesions were subsequently biopsied and showed sarcoid, not malignancy. He noted skin lesions a few months ago. He had red-brown plaques and papules on his forearms and back. Biopsy showed non-caseating granulomas. We have done intralesional and topical steroids.

VisualDx helped me because I was able to check the sarcoid associations and eponymous syndromes to make sure he didn’t have anything else underlying.”

What is sarcoidosis?

Sarcoidosis is an immune-mediated systemic disorder typified by granuloma formation of the lung parenchyma and the skin, but it can affect many other organs. The inciting immune activating agent remains unknown (hypotheses include autoimmune, infectious, and environmental triggers). The disease affects all ages and ethnicities and both sexes, with peak incidence demonstrating a bimodal age distribution: ages 25-35 and 45-65. It is most commonly observed in women. Cutaneous disease is often the first sign of systemic sarcoidosis.

What should we be aware of when making a diagnosis?

• Some lesions of sarcoidosis can have significant atrophy in addition to infiltration.
• A yellow-brown “apple jelly” color can be seen when a lesion is compressed with a glass slide (diascopy).
• Skin biopsy of a sarcoid lesion will show noncaseating granuloma formation.

How can we treat this?

• Corticosteroids remain the mainstay of therapy. Therapeutic strategy should be dictated by the severity and level of systemic involvement.
• Steroid sparing therapy should be instituted in steroid-resistant sarcoidosis or in patients who are unable to tolerate steroids.