Ulcerative lesions are the initial presenting sign in one third of reported cases. 3 Most ulcers develop within papulonodular lesions. Lower-extremity lesions predominate. Facial and generalized ulcers occur less frequently. Extracutaneous sarcoidosis is common in patients with ulcerative lesions.
Histopathological examination demonstrates typical noncaseating granulomas.
Corticosteroids are the primary treatment modality, with methotrexate used for refractory cases. The FPDL 1 and carbon dioxide laser 5 have been reported to be successful in treating lupus pernio. She had sarcoidosis for over a decade without ulceration. It is significant that within 3 weeks of FPDL therapy, both the laser-treated lesions and the untreated lesions ulcerated. We believe that laser therapy should be used cautiously in patients with sarcoidosis.