Photo Rounds Friday Archive
Red and swollen area on nose
Post Date: 07/24/2009
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A 45-year-old black woman sought treatment for a red and swollen area on her nose. The lesions, which had developed 2 months earlier, were not painful or pruritic but the patient was worried about their appearance. She had hypertension, but no other medical problems. She had no respiratory complaints.
What's your diagnosis?
The patient’s physician diagnosed cutaneous sarcoidosis involving the nasal rim. This presentation of sarcoidosis is called “lupus pernio.” Lupus pernio type sarcoidosis presents with shiny pink to purplish lesions typically affecting the nose, cheeks, ears, and lips. The differential diagnosis for lupus pernio includes lupus erythematosus, granuloma annulare, and morphea. Sarcoidosis may involve the upper respiratory tract with pulmonary fibrosis. Less frequently, it may be associated with chronic uveitis and bone cysts. Sarcoidosis may present with erythema nodosum.
A shave biopsy confirmed the diagnosis in this patient. If the lesions are not on the nasal ala, a punch biopsy is generally preferred. This patient had a normal chest x-ray and no evidence of pulmonary involvement.
Treatment for localized sarcoidosis on the face includes topical or intralesional steroids. If the cutaneous sarcoidosis is more widespread, then treatment options include prednisone, methotrexate, and hydroxychloroquine. This patient’s physician started her on topical triamcinolone cream twice daily to the affected area.
Photos and text for Photo Rounds Friday courtesy of Richard Usatine, MD. This case was adapted from: Sarabi K, Khachemoune A. Sarcoidosis. In: Usatine R, Smith M, Mayeaux EJ, Chumley H, Tysinger J, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:539-544.
To learn more about The Color Atlas of Family Medicine, see: