Carta científica
Sarcoidosis cutánea aislada
Isolated Cutaneous Sarcoidosis
Abdullah Şimşek
, Halil Çelikten, İlhami Yapıcı
Corresponding author
Chest Diseases, Türkan Akyol Chest Diseases Public Hospital, Bursa, Turquía
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Entre un 20 y un 35% de los pacientes que padecen sarcoidosis sistémica presentan afectación cutánea. Esta se observa con mayor frecuencia en personas jóvenes y de mediana edad con sarcoidosis de inicio agudo caracterizada por eritema nudoso, adenopatías hiliares bilaterales y poliartralgia o poliartritis<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a>. Sin embargo, en la sarcoidosis crónica, se pueden observar lesiones cutáneas aisladas en ausencia de afectación sistémica<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a>. Describimos un caso de sarcoidosis cutánea (SC) aislada.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Una mujer no fumadora de 48 años de edad acudió a nuestra consulta por presentar pápulas difusas en el rostro y placas en las extremidades superiores (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>). Estas lesiones habían aparecido 3 años antes y, aunque al inicio eran unas pequeñas pápulas rojizas en las extremidades, con el tiempo se habían hecho más grandes. La analítica mostró una concentración sérica de la enzima conversora de angiotensina (ECA) de 8,1<span class="elsevierStyleHsp" style=""></span>μg/l (intervalo de referencia: 8,0-52,0<span class="elsevierStyleHsp" style=""></span>μg/l); hemoglobina: 10,1<span class="elsevierStyleHsp" style=""></span>g/l; velocidad de sedimentación globular (VSG): 45<span class="elsevierStyleHsp" style=""></span>mm/h; y calcio sérico: 9<span class="elsevierStyleHsp" style=""></span>mg/dl (intervalo de referencia: 8,8-10,89<span class="elsevierStyleHsp" style=""></span>mg/dl). La radiología de tórax fue normal. El examen histopatológico de la biopsia cutánea mostró granulomas no caseificantes y, en función de estos hallazgos, el diagnóstico fue de sarcoidosis.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Se inició tratamiento con una dosis de 40<span class="elsevierStyleHsp" style=""></span>mg de metilprednisolona, que se redujo de forma gradual hasta 16<span class="elsevierStyleHsp" style=""></span>mg. Las lesiones de la paciente mejoraron notablemente, especialmente las del rostro, pero las placas de las extremidades mejoraron poco.</p><p id="par0020" class="elsevierStylePara elsevierViewall">La sarcoidosis es más frecuente en pacientes entre 20 y 40 años de edad, y su prevalencia es mayor en mujeres. La afectación exclusivamente cutánea es rara, pues se da en únicamente el 4-5% de los pacientes<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a>. La enfermedad puede ser leve o severa, autolimitada o crónica, y presentar una afectación limitada o extensa. Las manifestaciones clínicas de la sarcoidosis cutánea son muy variadas y comprenden lesiones maculopapulares de diferentes tamaños, cambios en cicatrices antiguas, lupus pernio, formación de placas, lesiones subcutáneas, etc.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a>.</p><p id="par0025" class="elsevierStylePara elsevierViewall">En las pruebas analíticas, las alteraciones frecuentes incluyen elevación de la VSG, anemia, leucopenia e hipercalcemia; nuestra paciente presentaba VSG elevada y anemia. El aumento de la concentración sérica de la ECA solo se observa en el 50% de los casos, por lo que este parámetro no puede considerarse un indicador fiable de SC y, en nuestro caso, era normal.</p><p id="par0030" class="elsevierStylePara elsevierViewall">La SC con afectación multisistémica se trata con corticoides tópicos o sistémicos<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a>. Es posible que los pacientes con lesiones aisladas y asintomáticos no precisen corticoesteroides sistémicos, pero deberán seguir controles periódicos.</p><p id="par0035" class="elsevierStylePara elsevierViewall">La SC aislada es una presentación infrecuente de la enfermedad, por lo que es probable que no se diagnostique. El diagnóstico definitivo de sarcoidosis requiere la práctica de una biopsia.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0040" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ningún conflicto de intereses.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicto de intereses" ] 1 => array:1 [ "titulo" => "Bibliografía" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:6 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 750 "Ancho" => 1000 "Tamanyo" => 118173 ] ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Erythema nodosum: Etiologic and predictive factors in a defined population" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. García-Porrúa" 1 => "M.A. González-Gay" 2 => "M. Vázquez-Caruncho" 3 => "L. López-Lazaro" 4 => "M. Lueiro" 5 => "M.L. Fernández" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/1529-0131(200003)43:3<584::AID-ANR15>3.0.CO;2-6" "Revista" => array:6 [ "tituloSerie" => "Arthritis Rheum" "fecha" => "2000" "volumen" => "43" "paginaInicial" => "584" "paginaFinal" => "592" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10728752" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A.V. Samtsov" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Dermatol" "fecha" => "1992" "volumen" => "31" "paginaInicial" => "385" "paginaFinal" => "391" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1512087" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous sarcoidal granulomas and the development of systemic sarcoidosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Hanno" 1 => "A. Needelman" 2 => "R.A. Eiferman" 3 => "J.P. Callen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Arch Dermatol" "fecha" => "1981" "volumen" => "117" "paginaInicial" => "203" "paginaFinal" => "207" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7212741" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Isolated cutaneous sarcoidosis: A new insight into the old entity" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H.K. Kumar" 1 => "M.N. Gayathri" 2 => "M. Bharathi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.7860/JCDR/2013/6108.3303" "Revista" => array:6 [ "tituloSerie" => "J Clin Diagn Res" "fecha" => "2013" "volumen" => "7" "paginaInicial" => "1725" "paginaFinal" => "1726" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24086892" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cutaneous Sarcoidosis without systemic involvement" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "G. Singh" 1 => "P. Sangolli" 2 => "K. Dash" 3 => "S. Grove" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Indian J Dermatol Venereol Leprol" "fecha" => "2000" "volumen" => "66" "paginaInicial" => "43" "paginaFinal" => "44" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20877023" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005200000004/v1_201603270531/S0300289615001945/v1_201603270531/es/main.assets" "Apartado" => array:4 [ "identificador" => "49741" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Scientific Letters / Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005200000004/v1_201603270531/S0300289615001945/v1_201603270531/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289615001945?idApp=UINPBA00003Z" ]
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| 2020 August | 129 | 27 | 156 |
| 2020 July | 114 | 19 | 133 |
| 2020 June | 136 | 17 | 153 |
| 2020 May | 110 | 18 | 128 |
| 2020 April | 158 | 17 | 175 |
| 2020 March | 137 | 19 | 156 |
| 2020 February | 194 | 19 | 213 |
| 2020 January | 184 | 17 | 201 |
| 2019 December | 190 | 21 | 211 |
| 2019 November | 109 | 24 | 133 |
| 2019 October | 103 | 11 | 114 |
| 2019 September | 166 | 8 | 174 |
| 2019 August | 101 | 15 | 116 |
| 2019 July | 97 | 25 | 122 |
| 2019 June | 112 | 12 | 124 |
| 2019 May | 157 | 19 | 176 |
| 2019 April | 169 | 24 | 193 |
| 2019 March | 85 | 20 | 105 |
| 2019 February | 52 | 19 | 71 |
| 2019 January | 32 | 8 | 40 |
| 2018 December | 59 | 15 | 74 |
| 2018 November | 77 | 26 | 103 |
| 2018 October | 115 | 26 | 141 |
| 2018 September | 66 | 11 | 77 |
| 2018 August | 1 | 0 | 1 |
| 2018 May | 34 | 0 | 34 |
| 2018 April | 46 | 5 | 51 |
| 2018 March | 52 | 8 | 60 |
| 2018 February | 59 | 5 | 64 |
| 2018 January | 125 | 3 | 128 |
| 2017 December | 60 | 10 | 70 |
| 2017 November | 24 | 6 | 30 |
| 2017 October | 23 | 6 | 29 |
| 2017 September | 17 | 9 | 26 |
| 2017 August | 26 | 5 | 31 |
| 2017 July | 35 | 3 | 38 |
| 2017 June | 39 | 9 | 48 |
| 2017 May | 39 | 16 | 55 |
| 2017 April | 30 | 21 | 51 |
| 2017 March | 32 | 34 | 66 |
| 2017 February | 11 | 3 | 14 |
| 2017 January | 14 | 11 | 25 |
| 2016 December | 27 | 18 | 45 |
| 2016 November | 49 | 26 | 75 |
| 2016 October | 36 | 22 | 58 |
| 2016 September | 33 | 8 | 41 |
| 2016 August | 59 | 16 | 75 |
| 2016 July | 45 | 10 | 55 |
| 2016 June | 1 | 0 | 1 |
| 2016 May | 7 | 2 | 9 |
| 2016 April | 132 | 9 | 141 |
| 2016 March | 8 | 2 | 10 |
| 2016 February | 2 | 2 | 4 |
| 2016 January | 1 | 1 | 2 |
| 2015 December | 1 | 1 | 2 |
| 2015 November | 12 | 0 | 12 |
Show all
