Cutaneous Sarcoidosis Treatment Quiz
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Questions and Answers

What is the characteristic feature of sarcoidosis?

  • Bacterial infection
  • Granulomatous inflammation (correct)
  • Excessive bleeding
  • Viral replication

    • What is theorized to be the cause of sarcoidosis?

  • Genetic mutation
  • Metabolic disorder
  • Hyperactivation of the immune system (correct)
  • Environmental pollution

    • At what age is disease onset most common for sarcoidosis?

  • Third decade of life (correct)
  • First decade of life
  • Seventh decade of life
  • Fifth decade of life

    • Where does sarcoidosis have a higher incidence?

    <p>Greater distance from the equator</p> Signup and view all the answers

    What condition has replaced syphilis as the great mimicker for dermatologists?

    <p>Sarcoidosis</p> Signup and view all the answers

    What is the characteristic color change seen in the papular form of sarcoidosis when a glass slide is pressed to the skin?

    <p>Translucent red-brown color</p> Signup and view all the answers

    What feature of sarcoidosis lesions can be appreciated with diascopy?

    <p>Nodular quality</p> Signup and view all the answers

    What is a distinguishing dermoscopic finding associated with cutaneous sarcoidosis?

    <p>Pink homogenous background</p> Signup and view all the answers

    Where do papular lesions of sarcoidosis occur most commonly?

    <p>Face and neck</p> Signup and view all the answers

    What reflects mild epidermal atrophy in the lesions of sarcoidosis?

    <p>Waxy appearance</p> Signup and view all the answers

    What condition may exhibit similar diascopic properties to sarcoidosis?

    <p>Lupus vulgaris</p> Signup and view all the answers

    What is the characteristic feature of lupus pernio?

    <p>Symmetric violaceous plaques and nodules on the nose and digits</p> Signup and view all the answers

    What was the initial misunderstanding regarding the name 'lupus pernio'?

    <p>It was mistaken to be related to lupus vulgaris and cold injury</p> Signup and view all the answers

    What is a potential consequence of lupus pernio lesions extending into the nasal sinus?

    <p>It causes nasal crusting and epistaxis</p> Signup and view all the answers

    What is the association between angiolupoid lesions and lupus pernio?

    <p>Angiolupoid lesions are a variant of lupus pernio</p> Signup and view all the answers

    What is a potential manifestation of cutaneous sarcoidosis at traumatized skin sites?

    <p>Inflammation and infiltration with sarcoidal granulomas</p> Signup and view all the answers

    What may be the only finding in a patient with significant systemic involvement of sarcoidosis?

    <p>Infiltrated scars</p> Signup and view all the answers

    What does the presence of sarcoidal granulomas surrounding foreign material NOT do?

    <p>Establish the diagnosis of sarcoidosis</p> Signup and view all the answers

    What is a common characteristic of scar tissue affected by cutaneous sarcoidosis?

    <p>Inflammation and granuloma infiltration</p> Signup and view all the answers

    Where does cutaneous sarcoidosis occur preferentially?

    <p>Around embedded foreign material such as silica and tattoo ink</p> Signup and view all the answers

    What may infiltrated scars be in a patient with significant systemic involvement?

    <p>Tender or pruritic</p> Signup and view all the answers

    What is a potential cutaneous manifestation of sarcoidosis that may occur on the extremities?

    <p>Subcutaneous nodules</p> Signup and view all the answers

    Which cutaneous manifestation of sarcoidosis is associated with induration upon careful palpation?

    <p>Hypopigmented macules</p> Signup and view all the answers

    In cutaneous sarcoidosis, what manifestation may occur on hair-bearing skin like the face and scalp?

    <p>Alopecia</p> Signup and view all the answers

    What characterizes the reversibility of alopecia in cutaneous sarcoidosis?

    <p>The degree of fibrosis and destruction of the hair follicle</p> Signup and view all the answers

    What rare manifestation of cutaneous sarcoidosis may lead to nail changes?

    <p>Granulomas in the nail matrix</p> Signup and view all the answers

    Which type of cutaneous sarcoidosis may present as persistent subcutaneous nodules?

    <p>Darier-Roussy sarcoid</p> Signup and view all the answers

    What may be appreciated upon careful palpation of the hypopigmented macules in darkly pigmented persons with sarcoidosis?

    <p>Induration</p> Signup and view all the answers

    In cutaneous sarcoidosis, where may alopecia occur?

    <p>Face and scalp</p> Signup and view all the answers

    What rare nail changes may occur in cutaneous sarcoidosis?

    <p>Subungual hyperkeratosis</p> Signup and view all the answers

    What may infiltrate the gingiva and mimic Wegner granulomatosis in sarcoidosis?

    <p>Sarcoidal granulomas</p> Signup and view all the answers

    What is one cause of Mikulicz syndrome, the bilateral enlargement of the lacrimal, parotid, sublingual, and submandibular glands?

    <p>Sarcoidosis</p> Signup and view all the answers

    What is the characteristic feature of Mikulicz syndrome?

    <p>Bilateral enlargement of the lacrimal, parotid, sublingual, and submandibular glands</p> Signup and view all the answers

    What is the main nonspecific cutaneous manifestation of sarcoidosis?

    <p>Erythema nodosum</p> Signup and view all the answers

    What condition is frequently the initial manifestation of sarcoidosis, characterized by erythema nodosum, bilateral hilar adenopathy, arthralgia, and fever?

    <p>Lofgren syndrome</p> Signup and view all the answers

    What is a potential consequence of sarcoid lesions infiltrating the parenchyma of the lungs?

    <p>Pulmonary fibrosis</p> Signup and view all the answers

    Which of the following may occur due to fibrotic disease in sarcoidosis?

    <p>Pulmonary hypertension</p> Signup and view all the answers

    What can be a consequence of lesions distorting the airways in sarcoidosis?

    <p>Obstructive lung disease</p> Signup and view all the answers

    When are pulmonary function tests more likely to be abnormal in sarcoidosis?

    <p>When chest radiographs reveal abnormal lung parenchyma</p> Signup and view all the answers

    What is the most common organ involved with sarcoidosis?

    <p>Lung</p> Signup and view all the answers

    What are the usual findings on pulmonary examination in patients with sarcoidosis?

    <p>Absent findings</p> Signup and view all the answers

    What is the typical symptomatology of patients with sarcoidosis?

    <p>Asymptomatic</p> Signup and view all the answers

    What is the most common symptom associated with ocular involvement in sarcoidosis?

    <p>Dryness and itching</p> Signup and view all the answers

    Which syndrome is a classic presentation of sarcoidosis involving fever, parotid gland enlargement, facial palsy, and anterior uveitis?

    <p>Heerfordt syndrome</p> Signup and view all the answers

    What is the main cause of clinical problems related to cardiac involvement in sarcoidosis?

    <p>Arrhythmias</p> Signup and view all the answers

    What percentage of patients with sarcoidosis exhibit clinical evidence of cardiac involvement?

    <p>5%</p> Signup and view all the answers

    What part of the nervous system may be affected by neurosarcoidosis?

    <p>Both central and peripheral nervous system</p> Signup and view all the answers

    How does nephrolithiasis occur in renal sarcoidosis?

    <p>Due to direct granulomatous inflammation in the kidney</p> Signup and view all the answers

    What is the common characteristic of liver involvement in hepatic sarcoidosis?

    <p>Histologic evidence of sarcoidal granulomas</p> Signup and view all the answers

    What condition is commonly associated with nasal sarcoidosis of the upper respiratory tract?

    <p>Severe epistaxis and nasal crusting</p> Signup and view all the answers

    What may lead to leukopenia in sarcoidosis?

    <p>Spleen involvement</p> Signup and view all the answers

    Which manifestation is associated with bone marrow involvement in sarcoidosis?

    <p>Thrombocytopenia</p> Signup and view all the answers

    What is the usual cause of liver biopsy in patients with sarcoidosis?

    <p>Histologic evidence of granulomas</p> Signup and view all the answers

    What is the most common symptom associated with ocular involvement in sarcoidosis?

    <p>Redness, burning, itching, and dryness</p> Signup and view all the answers

    Which part of the eye is most commonly involved in sarcoidosis?

    <p>Uvea</p> Signup and view all the answers

    What can result from activated sarcoidal macrophages having increased 1-hydroxylase activity?

    <p>Hypercalcemia, hypercalciuria, and nephrolithiasis</p> Signup and view all the answers

    What is the recommended diagnostic test for every patient diagnosed with sarcoidosis?

    <p>Electrocardiogram</p> Signup and view all the answers

    What might happen when the myocardium is massively infiltrated with granulomas?

    <p>Cardiogenic shock and heart failure</p> Signup and view all the answers

    What is the triggering factor for sarcoidosis?

    <p>Exposure to an antigen(s)</p> Signup and view all the answers

    Which cells recognize, process, and present the processed sarcoid-inducing antigen to CD4+ T cells?

    <p>Macrophages</p> Signup and view all the answers

    What do activated macrophages produce that induces lymphocytes to shift toward a Th1 profile?

    <p>Interleukin (IL)-12</p> Signup and view all the answers

    What cytokine is released by activated T cells that recruits monocytes and macrophages to the site of disease activity?

    <p>Interleukin (IL)-2</p> Signup and view all the answers

    What is the putative antigen(s) triggering the immunologic cascade?

    <p>Unknown</p> Signup and view all the answers

    What plays a role in the development of sarcoidosis lesions in addition to CD4+ T cells of the Th1 subtype?

    <p>(Th17) subtype and Th17 cytokines</p> Signup and view all the answers

    What is a common risk factor associated with sarcoidosis?

    <p>Genetic mutations related to the immune system</p> Signup and view all the answers

    Which infectious agent is NOT associated with sarcoidosis according to the passage?

    <p>Streptococcus pyogenes</p> Signup and view all the answers

    What is a documented environmental risk factor for developing sarcoidosis?

    <p>Exposure to mineral dusts such as silica and iron</p> Signup and view all the answers

    Who is more likely to develop sarcoidosis based on smoking habits?

    <p>Non-smokers</p> Signup and view all the answers

    What does the interplay of antigenic and genetic risk factors suggest about sarcoidosis?

    <p>It has multiple causes</p> Signup and view all the answers

    What is the association between relatives of an affected person and the development of sarcoidosis?

    <p>&quot;Relatives of an affected person are more likely to develop disease than is the general population&quot;</p> Signup and view all the answers

    What is associated with the development of sarcoidosis?

    <p>Mycobacteria</p> Signup and view all the answers

    What is associated with increased risk of sarcoidosis?

    <p>Firefighters</p> Signup and view all the answers

    What plays a major role in determining susceptibility to sarcoidosis?

    <p>Genetics</p> Signup and view all the answers

    Which genetic factor is associated with different presentations of sarcoidosis?

    <p>TNF</p> Signup and view all the answers

    What is thought to be the cause of sarcoidosis?

    <p>Specific interaction between exposures and genetic programming</p> Signup and view all the answers

    What is associated with different phenotypic expressions of sarcoidosis?

    <p>Mutations in genes related to the immune system</p> Signup and view all the answers

    What is required for the diagnosis of sarcoidosis?

    <p>Presence of noncaseating granulomas in a single organ system</p> Signup and view all the answers

    In what scenario can the diagnosis of sarcoidosis be accepted without a tissue biopsy?

    <p>A patient with asymptomatic bilateral hilar adenopathy noted on chest radiograph</p> Signup and view all the answers

    What does the presence of noncaseating granulomas in a single organ system indicate?

    <p>Requires histologic confirmation in the second organ</p> Signup and view all the answers

    What is necessary for confirmation of sarcoidosis?

    <p>Histologic confirmation in two separate organs</p> Signup and view all the answers

    When can the diagnosis of sarcoidosis be assumed without a tissue biopsy?

    <p>When the clinical presentation is typical for the disease</p> Signup and view all the answers

    What is true about isolated skin granulomas in relation to sarcoidosis?

    <p>They should not be assumed to represent sarcoidosis</p> Signup and view all the answers

    What is the recommended test for evaluating the total granuloma burden in sarcoidosis?

    <p>Serum angiotensin-converting enzyme (SACE) levels</p> Signup and view all the answers

    Which test is abnormal in more than 90% of patients with sarcoidosis?

    <p>Posteroanterior chest radiograph</p> Signup and view all the answers

    What is the clinical role of computed tomography in the management of pulmonary sarcoidosis?

    <p>Insufficient evidence for a clinical role</p> Signup and view all the answers

    What is the mechanism of gallium-67 uptake in sarcoidosis?

    <p>Increased capillary permeability of gallium</p> Signup and view all the answers

    What is a highly specific sign for identifying sarcoidosis on gallium-67 scanning?

    <p>Bilateral hilar and right paratracheal uptake (lambda sign)</p> Signup and view all the answers

    What is the role of fluorodeoxyglucose positron emission tomography scanning in sarcoidosis?

    <p>Revealing granulomatous inflammation and monitoring treatment response</p> Signup and view all the answers

    What type of cells are commonly present within the sarcoidal granuloma?

    <p>Epithelioid cells</p> Signup and view all the answers

    What should be routinely performed to consider alternative diagnoses to sarcoidosis?

    <p>Stains and cultures for mycobacteria and fungi</p> Signup and view all the answers

    What is a characteristic feature of cutaneous granulomas that may help in differential diagnosis?

    <p>Epithelioid cells surrounded by lymphocytes ('naked granulomas')</p> Signup and view all the answers

    What is a potential role of magnetic resonance imaging in sarcoidosis?

    <p>Revealing extrathoracic disease involvement</p> Signup and view all the answers

    What is necessary for the diagnosis of sarcoidosis?

    <p>Confirmation of granulomatous involvement in at least 2 separate organs</p> Signup and view all the answers

    When can isolated skin granulomas be assumed to represent sarcoidosis?

    <p>When no alternative diagnoses are apparent</p> Signup and view all the answers

    What does confirmation of sarcoidosis require?

    <p>Proof of granulomatous involvement in at least 2 separate organs</p> Signup and view all the answers

    In which scenario can the diagnosis of sarcoidosis be accepted without a tissue biopsy?

    <p>When cutaneous manifestations are typical for the disease</p> Signup and view all the answers

    What is the significance of serum angiotensin-converting enzyme (SACE) levels in the diagnosis of sarcoidosis?

    <p>Elevated SACE levels are insufficiently specific for the diagnosis of sarcoidosis and are also insufficiently sensitive to exclude the diagnosis.</p> Signup and view all the answers

    What is the role of posteroanterior chest radiograph in diagnosing sarcoidosis?

    <p>It is abnormal in more than 90% of patients with sarcoidosis.</p> Signup and view all the answers

    What is the characteristic feature of gallium-67 scanning in identifying sarcoidosis?

    <p>Gallium uptake in thoracic and extrathoracic sites is typically absent in areas of skin involvement in sarcoidosis.</p> Signup and view all the answers

    What is the significance of gadolinium enhancement on nuclear magnetic resonance imaging in sarcoidosis?

    <p>It plays a major role in detecting neurosarcoidosis and monitoring therapeutic response.</p> Signup and view all the answers

    What is the role of fluorodeoxyglucose positron emission tomography scanning in sarcoidosis?

    <p>It is more sensitive in revealing granulomatous inflammation than gallium-67 scanning.</p> Signup and view all the answers

    What percentage of cases show pulmonary parenchymal infiltrates in sarcoidosis?

    <p>25% to 60%</p> Signup and view all the answers

    What is noted in 50% to 85% of sarcoidosis cases?

    <p>Asymptomatic hilar adenopathy</p> Signup and view all the answers

    What stage of sarcoidosis is characterized by pulmonary infiltrates only?

    <p>Stage III</p> Signup and view all the answers

    Which of the following is associated with a more than 80% rate of spontaneous remission within 4 to 6 weeks?

    <p>Erythema nodosum with fever and arthralgia</p> Signup and view all the answers

    Which cutaneous manifestation of sarcoidosis indicates chronic disease and is associated with upper respiratory tract involvement, pulmonary fibrosis, and bony cysts?

    <p>Lupus pernio</p> Signup and view all the answers

    Which of the following is associated with a worse prognosis in sarcoidosis?

    <p>Forced vital capacity less than 1.5 L</p> Signup and view all the answers

    What is the general prognosis of sarcoidosis?

    <p>Favorable prognosis for all types of sarcoidosis</p> Signup and view all the answers

    What causes almost all significant impairment from sarcoidosis?

    <p>Hyalinization of fibrotic response</p> Signup and view all the answers

    What is the likely cause of the propensity for a brisk fibrotic response in sarcoidosis?

    <p>Host response</p> Signup and view all the answers

    Which part of the body accounts for most of the remaining deaths related to sarcoidosis in the United States?

    <p>Central nervous system involvement</p> Signup and view all the answers

    What is the characteristic feature of skin lesions from fibrosis in sarcoidosis?

    <p>Ulceration or destruction of adjacent bone and cartilage</p> Signup and view all the answers

    What is the typical remission period for sarcoidosis after diagnosis?

    <p>2-5 years</p> Signup and view all the answers

    What is the usual prognosis for liver and peripheral lymph node sarcoidosis?

    <p>Favorable</p> Signup and view all the answers

    What is the main cause of significant impairment from sarcoidosis?

    <p>Development of fibrosis</p> Signup and view all the answers

    What may resolve in cutaneous sarcoidosis with or without scarring or pigmentary changes?

    <p>Skin lesions</p> Signup and view all the answers

    Which topical medication may be effective for cutaneous sarcoidosis without causing skin atrophy and hypopigmentation?

    <p>Tacrolimus ointment</p> Signup and view all the answers

    What is the recommended initial dose of prednisone equivalent for the treatment of pulmonary sarcoidosis?

    <p>20 to 40 mg/day</p> Signup and view all the answers

    When should an attempt be made to taper the corticosteroid dose for sarcoidosis treatment?

    <p>Within 9 to 12 months of therapy initiation</p> Signup and view all the answers

    What is the most reliable immediate initial therapy for sarcoidosis?

    <p>Systemic corticosteroids</p> Signup and view all the answers

    What is the usual range for tapering the corticosteroid dosage over a few months for sarcoidosis treatment?

    <p>0.1 to 0.2 mg/kg</p> Signup and view all the answers

    What is the recommended initial dose of prednisone equivalent for the treatment of cutaneous sarcoidosis?

    <p>$40$ to $60$ mg/day</p> Signup and view all the answers

    Which medication is considered the most studied steroid-sparing agent for the treatment of sarcoidosis?

    <p>Methotrexate</p> Signup and view all the answers

    Which drug, used for sarcoidosis, has a higher potential of causing retinal damage?

    <p>Chloroquine</p> Signup and view all the answers

    Which medication has been reported to improve skin sarcoidosis in case series and may take up to 2 years to be effective?

    <p>Doxycycline</p> Signup and view all the answers

    Which regimen has shown some effectiveness for the treatment of sarcoidosis, with clinical trials currently ongoing to better assess its usefulness?

    <p>CLEAR (combined levofloxacin, ethambutol, azithromycin, and rifampin) regimen</p> Signup and view all the answers

    Which medication is reserved for severe or potentially life-threatening disease due to its significant side effect profile, including carcinogenic potential?

    <p>Cyclophosphamide</p> Signup and view all the answers

    Which medication is effective for many forms of sarcoidosis but should be carefully monitored due to liver function tests and blood cell counts?

    <p>Cyclophosphamide</p> Signup and view all the answers

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