Cutaneous sarcoidosis in black South Africans

Background It has been observed that, in the USA, sarcoidosis is more commo n in African-Americans than in other races. It has also been noted that sar coidosis in African-Americans is characterized by more severe extrapulmonary involvemen t and more exuberant skin lesions. There is little information on sarcoidos is in black Africans. Methods Fifty-four black South African patients with cutaneous lesions of s arcoidosis proven by biopsy were prospectively studied. Dermatologic and op hthalmologic examinations and chest X-rays were performed in all patients. Other investigations relevant in the diagnosis of extracutaneous sarcoidosi s were also performed in a variable number of patients. Results In 40 patients (71%), systemic sarcoidosis was found with lung, eye , and acral bone involvement being most common. Great variations in the mor phology of skin lesions were observed. In one-quarter of patients, atypical cutaneous lesions (hypopigmented, ichthyosiform, lymphedematous, mutilatin g, ulcerative, verrucous) were found. Lupus pernio, once thought to be conf ined to Northern Europe, was observed in five patients in the subtropical m ilieu of South African Transvaal. Sarcoidal dactylitis with nail changes wa s seen in eight patients. Fibrinoid necrosis was found in 12% of the biopsi es. Conclusions Sarcoidosis in black South Africans is characterized by extensi ve cutaneous involvement. The lesions are morphologically extremely variabl e, frequently atypical, and often demonstrate fibrinoid necrosis on histolo gy.