Another useful test is the gallium-67 scan. It is a more sensitive measure of pulmonary involvement than plain chest X-rays and can also detect subclinical disease in the parotid gland. When considering treatment options for sarcoidosis, it should be remembered that many patients will show spontaneous resolution without intervention. When pulmonary manifestations are present, treatment is generally required. Extrapulmonary manifestations require treatment when major organs, neurologic, ocular, deforming skin lesions, or aerodigestive tract involvement are present.
Oral steroids remain the cornerstone of treatment, but there is no set protocol.
Patients are usually treated for at least six months initially. ACE or the ESR levels can be used to monitor response to the medical regimen. Local steroids either as topical ointment or as nasal sprays can be of benefit when skin or nasal involvement is present. Those with progressive disease can have a relentless course that can end in death due to either respiratory or cardiac failure. Those patients with laryngeal involvement also require oral steroids and it remains the treatment of choice.