A healthy 35-year-old African American woman presented for evaluation of hair loss (Figure (Figure11). Examination of her scalp revealed areas of alopecia with absent hair follicles, erythematous papules, and a few pustules, consistent with a scarring (cicatricial) form of alopecia. Additionally, there were hypopigmented lesions on her arms (Figure (Figure22) and targetoid plaquelike lesions on her legs (Figure (Figure33).

Sarcoidosis is a multisystem granulomatous disease of unknown etiology that involves the lungs in >90% of patients, eyes in 25% to 50%, lymph nodes in 75%, and skin in 25% to 30% (1–4). Pure cutaneous involvement is seen in approximately 25% of patients (5). The mucocutaneous lesions of sarcoidosis are diverse (Table) and can be divided into those that are specific and those that are nonspecific. Specific lesions demonstrate histological evidence of noncaseating granulomas in the dermis and are associated with chronic disease. A recent review of cutaneous sarcoidosis found that 73% of the patients had specific lesions at the beginning of their disease, with 70% of those patients having systemic manifestations concomitantly. The remaining 30% developed systemic disease between 6 months and 3 years later (17, 28). Clinically, specific lesions include a wide variety of papules, plaques, lupus pernio (red-purple papules and plaques on the face and fingers), pits/spicules, and alopecia. Other specific lesions may be verrucous, angiolupoid (having a prominent vascular or telangiectatic component), ulcerative, mutilating, pustular, or erythrodermic. Nonspecific lesions do not reveal granulomatous inflammation in the dermis but are associated with systemic involvement of sarcoidosis. Examples of nonspecific lesions include erythema nodosum (17%), clubbing, calcinosis cutis, and erythema multiforme. Usually, nonspecific lesions such as erythema nodosum are associated with acute disease and portend a more favorable prognosis.