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Systemic Sarcoidosis With Unique Vulvar Involvement

Stacey Watkins, BA1; Aimen Ismail, BS1; Kristopher McKay, MD1; Kathleen Beckum, MD1; Vlada Groysman, MD1
[+] Author Affiliations
1Department of Dermatology, University of Alabama, Birmingham
JAMA Dermatol. 2014;150(6):666-667. doi:10.1001/jamadermatol.2013.7204.
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Sarcoidosis is a complex, multisystem disease with an unclear cause.1 Research suggests that the pathogenetic mechanism of sarcoidosis is dysregulation of the immune system in individuals with a genetic predisposition who are subsequently exposed to inciting environmental agents.2

Cutaneous sarcoidosis is often one of the earliest clinical signs of the disease and can be divided into 2 subclasses: specific and nonspecific lesions. Specific lesions are characterized by granulomas identified histologically and include macules, papules, plaques, annular lesions, lupus pernio, infiltration of scars, and subcutaneous nodules.3 Alternatively, nonspecific sarcoid lesions, including erythema nodosum, prurigo, or calcifications, are reactive inflammatory processes.3

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Figure 1.
The Vaginal Area of the Patient With Cutaneous Sarcoidosis

White, discolored patches are apparent in the posterior fourchette, which is the site from which the second biopsy specimen was taken (arrowhead).

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Figure 2.
Pathologic Specimens of Vulva in Patient With Cutaneous Sarcoidosis

A, Numerous, well-formed hypoinflammatory granulomas in the dermis (hematoxylin-eosin, original magnification ×40). B, Transepidermal elimination of granulomas in areas of epidermal acanthosis (hematoxylin-eosin, original magnification ×100).

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