Cutaneous manifestations of sarcoidosis in the united states: a nationwide questionnaire-based registry study

SESSION TITLE: Diffuse Lung Disease: There Is More to This Than Meets the Eye SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm PURPOSE: Cutaneous involvement is a common manifestation of sarcoidosis estimated to occur in up to a fourth of all patients. We aim to describe the demographics and clinical characteristics of patients with cutaneous manifestations of sarcoidosis in the United States based on a national registry questionnaire. METHODS: We conducted a retrospective study based on a national registry investigating 3,835 respondents to the Foundation for Sarcoidosis Research - Sarcoidosis Advanced Registry for Cures Questionnaire (FSR-SARC). The registry includes patient surveys completed between June 2014 and August 2019. Summary and univariate analyses were performed. RESULTS: A total of 917 (24%) patients with sarcoidosis with a mean (±SD) age of 55 (±12) had cutaneous manifestations; 81% (n=741) were females and 72% (n=660) were Caucasian. Patients with cutaneous manifestations were more likely to be female (81% vs 72%, p<0.0001) and Black (24% vs 14%; p<0.0001). There was no significant difference in age between patients with and without cutaneous manifestations (p=0.55). A dermatologist evaluated 50% (n=461) of these patients and a skin biopsy was performed in 27% (n=250). A kviem test was performed in 135 patients (15%). Multiorgan involvement (≥3 organs) was present in 724 patients (79%). Patients with cutaneous manifestations had significantly higher odds of multiorgan involvement (OR:5.5, 95%CI: 4.6-6.7, p<0.0001). The most common cutaneous manifestations include plaques (n=384, 42%), abnormal skin pigmentation (n=265, 29%), lupus pernio (n=250, 27%), scar and tattoo sarcoidosis (n=221, 24%), papules (n=214, 23%) and erythema nodosum (n=181, 20% of which n=87, 48% had Lofgren syndrome). Most patients received systemic steroids (n=708, 77%) and topical steroids (n=211, 23%). Other medications administered include cytotoxic medication (n=491, 54%), of which methotrexate was most used (n=331, 36%), hydroxychloroquine/chloroquine (n=305, 33%) and tumor necrosis factor (TNF) inhibitors (n=153, 17%) of which infliximab was the most used (n=110, 12%). Patients with cutaneous manifestations were more likely to have received hydroxychloroquine (OR: 3.2, 95%CI: 2.6-4.0, p<0.0001), cytotoxic agents (OR: 2.9, 95%CI: 1.7-2.5, p<0.0001) and TNF inhibitors (OR:1.7, 95%CI: 1.3-2.2, p<0.0001). There was no significant difference in systemic steroid use between patients with and without cutaneous manifestations (OR:1.2, 95%CI: 1.0-1.4, p=0.1). Other rare therapies include minocycline/doxycycline (n=12), corticosteroid skin injections (n=8), topical tacrolimus (n=3), laser surgery using carbon dioxide (n=2), thalidomide (n=2) and laser pulse therapy (n=1). CONCLUSIONS: Cutaneous manifestations of sarcoidosis are prevalent, especially in Black females, and are associated with systemic disease. Steroids, methotrexate, hydroxychloroquine and infliximab are the most common medication used. CLINICAL IMPLICATIONS: Cutaneous manifestations of sarcoidosis are more prevalent in Black females, are associated with systemic disease, and frequently require systemic therapy. DISCLOSURES: No relevant relationships by Diala Alawneh No relevant relationships by Sarah Alawneh No relevant relationships by Bashar Alzghoul No relevant relationships by Moustafa Younis