Sarcoid-specific cutaneous lesions include papules, plaques, subcutaneous nodules, scar sarcoidosis, and lupus pernio. Atypical skin presentations include ulcerative, psoriasiform, hypopigmented, verrucous, ichthyosiform, erythrodermic, lichenoid, cicatricial alopecia, and mutilating lesions. It is characterized by violaceous indurated lesions affecting the nose, cheeks, ears, lips, and forehead. Lupus pernio frequently occurs in association with pulmonary fibrosis, upper respiratory tract lesions, uveitis, and bone cysts. Its presence usually indicates a chronic course.
Ulcerative sarcoidosis is a rare cutaneous variant.
Women and blacks are twice as likely as men and whites to have ulcerative lesions. Most patients are less than 40 years old. Ulcerative lesions are the initial presenting sign in one third of reported cases. 3 Most ulcers develop within papulonodular lesions. Lower-extremity lesions predominate.