eMedicine Specialties > Dermatology > Reactive & Inflammatory Dermatoses

Sarcoidosis: Follow-up

Author: Karen Podlipsky Gould, MD, Physician, Private Practice
Coauthor(s): Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Contributor Information and Disclosures

Updated: Sep 8, 2009

Follow-up

Further Inpatient Care

  • Inpatient care is rarely needed for patients with cutaneous disease. However, in patients with respiratory insufficiency, hospitalization may be needed. Also, some patients may develop infections while on corticosteroids and/or immunosuppressive therapy that may result in hospitalization.

Further Outpatient Care

  • Follow-up care should be frequent for the first 2 years after diagnosis.
  • Patients with stage I disease can receive follow-up care twice yearly, whereas patients with more advanced lung disease should be seen more frequently. All patients should be monitored for at least 3 years after discontinuation of therapy.
  • During follow-up care, patients should have a history with review of systems, physical examination, chest radiography, and pulmonary function tests to evaluate for active or insidiously progressive disease.
  • Ophthalmologic assessment is needed initially—generally annually in all patients, and more frequently in those with ocular involvement. Therapeutic use of hydroxychloroquine (Plaquenil) may also warrant more frequent, detailed ophthalmologic examinations.
  • A large review by Ji et al of the Swedish Hospital Registry noted an elevated risk of skin cancer (especially squamous cell carcinoma), non-Hodgkin lymphoma, and leukemia in hospitalized patients with sarcoidosis, extending beyond the first year after hospitalization. Therefore, close follow up for malignancies is recommended.35

Prognosis

  • The course of the disease is variable, but spontaneous remission occurs in 50% of patients, while another one third of patients have eventual improvement. About 10-30% of patients have chronic or progressive disease.
  • The mortality rate is 1-6%. In the United States, mortality is most commonly due to respiratory failure from pulmonary involvement, cardiac involvement, or neurosarcoidosis. Complications of therapy are additional causes of morbidity and mortality.
  • Adverse prognostic factors include African American race, chronic cutaneous lesions, chronic uveitis, age at onset older than 40 years, cystic bone lesions, neurosarcoidosis, myocardial involvement, and stage III or IV pulmonary disease.

Miscellaneous

Medicolegal Pitfalls

  • Misdiagnosis
  • Toxicity from therapy, especially in an uninformed or unreliable patient
  • Failure to recognize systemic or ocular involvement
 


More on Sarcoidosis

Overview: Sarcoidosis
Differential Diagnoses & Workup: Sarcoidosis
Treatment & Medication: Sarcoidosis
Follow-up: Sarcoidosis
Multimedia: Sarcoidosis
References
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Further Reading

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Keywords

sarcoidosis, angiolupoid sarcoid, Besnier-Boeck-Schaumann disease, Boeck's sarcoid, Darier-Roussy disease, lupus pernio, multiple benign sarcoid of Boeck, Schaumann benign lymphogranulomatosis, subcutaneous sarcoid, uveoparotid fever

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Contributor Information and Disclosures

Author

Karen Podlipsky Gould, MD, Physician, Private Practice
Karen Podlipsky Gould, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Coauthor(s)

Jeffrey P Callen, MD, Professor of Medicine, Chief, Division of Dermatology, University of Louisville School of Medicine
Jeffrey P Callen, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and American College of Rheumatology
Disclosure: Amgen Honoraria Consulting; Abbott Honoraria Consulting; Electrical Optical Sciences Honoraria Consulting; Centocor Honoraria Consulting; Medicis Honoraria Consulting; Celgene Honoraria Consulting

Medical Editor

Ponciano D Cruz Jr, MD, Vice-Chair, JB Shelmire Professor, Department of Dermatology, University of Texas Southwestern Medical Center
Ponciano D Cruz Jr, MD is a member of the following medical societies: Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Catherine Quirk, MD, Clinical Assistant Professor, Department of Dermatology, Brown University
Catherine Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology
Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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