Granulomatous Skin Disease Research Articles

Granuloma annulare and possible relation to purified protein derivative administration: a case report

BackgroundGranuloma annulare is a noninfectious inflammatory granulomatous skin disease characterized by an erythematous or skin colored annulare plaque. The diagnosis of granuloma annulare may be challenging owing to its diverse morphology. In such cases, a correlation between the clinical findings and histologic findings are necessary.Case presentationWe report a case of granuloma annulare after purified protein derivative administration. A 56-year-old Caucasian female patient complained of mildly pruritic rashes which started on both arms and lower extremities, and eventually spread to both thighs, the left popliteal region, left upper back, and the right abdominal area. About 6 weeks prior to the eruption of the rashes, the patient had been given a purified protein derivative tuberculin skin test. Biopsy specimens revealed dermal histiocytes palisading around areas of mucin and degenerated collagen, confirming granuloma annulare. After treatment with 0.1% topical triamcinolone acetanide and 500 mg oral metronidazole, the patient’s lesions resolved.DiscussionRelatively little is known about granuloma annulare’s exact etiology. Granuloma annulare has four variations presenting as either localized, generalized, subcutaneous, or perforating and patch granuloma annulare. The clinical prognosis for granuloma annulare varies according to clinical subtypes. Proposed causal mechanisms of subcutaneous granuloma annulare include physical trauma, infections, immunizations, insect bites, diabetes mellitus, and alterations in the cell-mediated immune responses. The disease likely has an inflammatory component. Clinically, granuloma annulare may be confused with many other skin diseases.ConclusionThis case of subcutaneous granuloma annulare was reported since it is a rare dermatologic pathological condition that can be confused with other skin rash disorders. Although it is a benign self-limited disease, definitive diagnosis is important to rule out other pathologies with similar clinical appearances, such as cancer or human immunodeficiency virus (HIV) infection. Diagnostic confirmation is best made through skin biopsy.

The Intersection of Dermatological Dilemmas and Endocrinological Complexities: Understanding Necrobiosis Lipoidica-A Comprehensive Review.

Necrobiosis lipoidica (NL) is a rare granulomatous skin disorder with a predilection for females, often associated with diabetes mellitus (DM). This paper aims to comprehensively review the literature on NL, focusing on its association with DM, thyroid disorders, and the metabolic syndrome. A systematic search was conducted in English-language literature from inception to October 2023, utilizing PubMed. We identified 530 studies and selected 19 based on clinical significance, statistical support, and relevance to the paper's goals. The coexistence of NL and DM is prevalent, with rates ranging from 11% to 65.71%. NL may precede DM diagnosis and a correlation between NL and increased daily insulin requirements has been observed in such patients. NL is suggested as a potential prognostic marker for DM complications; however, recent studies question this association, highlighting the need for further research. Studies in the context of NL and Thyroid Disease indicate a correlation, especially with autoimmune thyroiditis. Regarding NL and Metabolic Syndrome, the prevalence of metabolic syndrome among NL patients is notably higher than in the general population. Additionally, DM patients with ulcerated NL commonly exhibit hypertension or obesity, raising questions about the potential influence of hypertension and obesity on NL ulcerations. Additional research is required to untangle the complex connections between NL and various comorbidities.

Post COVID - 19 Infection Diffuse Patch Granuloma Annulare in a Female Patient with Rheumatoid Arthritis: A Case Report

Introduction: Granuloma Annulare (GA) is a benign, usually self-limited, inflammatory granulomatous skin disorder of unknown etiology and with a diversity of clinical variants. Genetic factors, associations with predisposing diseases along with several triggers such as certain infections and vaccines, have been described, SARS-CoV-2 virus being one of them. Case Presentation: Localized, generalized and subcutaneous forms of GA have been reported following either SARS-CoV-2 infection or vaccination against the virus. Herein we present a case of diffuse patch GA in a middle-aged female patient with medical history of rheumatoid arthritis, one month after catching COVID -19 despite being fully vaccinated against the virus. Discussion: Overall, taking into account the relevant literature, the occurrence of GA after infection with SARS-CoV-2 as well as after vaccination seems to be attributed to the activation of an immunologic reaction rather than to the direct effect of the virus on the skin lesions, with the latest also appearing in the form of diffuse patch rashes. Conclusion: Dermatologists should be aware of such lesions appearing after COVID-19 infection or even vaccination especially in patients with autoimmune diseases.

Successful treatment of disseminated granuloma annulare with adalimumab

Granuloma annulare (GA) is a chronic inflammatory necrobiotic granulomatous skin disease, which is based on a delayed hypersensitivity reaction caused by the production of interferon- (IFN-) by tissue macrophages and th1-limocytes, tumor necrosis factor- (TNF-) and matrix metalloproteinases (MMP), which leads to the degradation of connective tissue.
 The most frequent form of GA if localized which is characterized clinically by grouped papules and plaques of red or pink color on the extremities. although disseminated variants of disease occur in 15% of all cases of ag. in contrast to the practically asymptomatic course of the localized form, typical signs of disseminated form are intensive sense of itching, the presence of at least ten foci of skin lesions, recurrent and resistance to treatment course.
 A 53-year-old female patient with a long-term recurrent course of annular granuloma after a weak clinical response to therapy with pentoxifilin, methotrexate and azathioprine turned to the dermatology department of the university hospital. In light of the lack of satisfactory treatment options anti-cytokine therapy with adalimumab was recommended at a daily dosage of 80 mg, once a week, for 2 weeks, then 1 time every two weeks for 1.5 months. Already on the 5th day after receiving the first injection, the patient reported that the feeling of itching disappeared. By the end of the second week of the induction phase of biotherapy, it became obvious that new rashes did not appear, and the old elements of the skin rash had significantly flattened, turned pale and decreased in volume. After the second week of consolidated therapy, the dermatologist confirmed the convalescence.

Necrobiosis lipoidica of the scalp

Necrobiosis lipoidica is a chronic granulomatous skin disease of a vascular-exchange nature from the group of localized skin lipoidosis, accompanied by the development of degenerative changes in the connective tissue.
 The reason for the development of necrobiosis lipoidica is unknown, but the most common theory remains the theory of vascular disorders, including the deposition of immune complexes (IgM, complement component C3), microangiopathic changes (deposition of a glycoprotein in the walls of blood vessels), as well as other combinations of inflammatory and structural changes leading to collagen degeneration and decreased perfusion and oxygenation of the skin. Necrobiosis lipoidica occurs in association with systemic diseases (sarcoidosis, autoimmune thyroiditis, inflammatory bowel disease, such as ulcerative colitis, and rheumatoid arthritis) and can also occur in otherwise healthy individuals. Necrobiosis lipoidica is closely associated with diabetes mellitus.
 The predominant localization of necrobiosis lipoidica is tibial surface of the legs. Atypical localization is: skin of the scalp and face.
 Clinical polymorphism of necrobiosis lipoidica, possibility of transition from one form to another, its combination with other dermatoses can pose difficult diagnostic questions for the doctor.
 The article describes our own clinical observation of a patient with complaints of rashes on the skin of the legs and scarring alopecia in the scalp. The focus on the scalp had a tendency to grow and signs of development of scarring alopecia. According to the results of a biopsy performed at the Rakhmanov Department of Skin and Veneral Diseases, I.M. Sechenov First Moscow State Medical University, was diagnosed with "Necrobiosis Lipoidica". The case was interesting due to the extreme rarity of rashes on the skin of the scalp and the absence of dermatoscopic features of lesions in this area. Due to ongoing therapy for a month, there was a positive effect in the form of a lack of growth of existing plaques and the appearance of new ones, a decrease in the brightness of the color of the rash, a partial regression with an outcome in residual hyperpigmentation.
 Thus, despite the absence of a gold standard in the treatment of necrobiosis lipoidica, the most well-studied group of drugs for the treatment of the disease at the moment are glucocorticoids, which confirms our experience. Therapy of patients with necrobiosis lipoidica should be carried out by an interdisciplinary team (dermatovenereologist, endocrinologist, therapist).

Asteroid bodies and autophagy.

Asteroid bodies are star-shaped inclusions in the cytoplasm of multinucleated giant cells. Asteroid bodies are not pathognomonic for a single disease, as these structures may be encountered in various granulomatous inflammatory conditions, including sarcoidosis, foreign body-type granulomas, and mycotic granulomas. In hematoxylin and eosin-stained light-microscopic preparations, asteroid bodies are strongly eosinophilic and surrounded by a halo of small clear vacuoles, as shown in Figures 1-3. Their bright red color reflects a high protein content, whereas the halo of clear vacuoles likely represents an artifact due to dissolved lipid material. In the past, asteroid bodies have intrigued several researchers and electron microscopy has been applied to unravel the composition and pathogenesis of this most peculiar microscopic phenomenon. About 40 years ago, it was discovered that the shape of asteroid bodies in Langhans-type giant cells is determined by the structure of the cytosphere, an ordered central subcellular structure consisting of a pool of centrioles, radiating microtubules, and radially arranged Golgi networks.1 In the 1990s, other investigators observed that the halo of clear vacuoles around the asteroid body contains loosely arranged myelin membranes, possibly representing excessive remnants of cellular membranes formed after the fusion of activated histiocytes.2 Notably, these seminal electron microscopic studies of asteroid bodies may point towards a possible role of autophagy in the formation of asteroid bodies. Herein, it is hypothesized that these structures contain aggregates of misfolded proteins and damaged organelles transported along a microtubular network and delivered to lysosomes in an organizing center close to the Golgi complex. In this pilot immunohistochemical study, evidence is provided that asteroid bodies contain both the autophagy receptor p62 (also known as SQSTM1) and the autophagosome marker LC3. For technical details of immunohistochemistry (IHC) please see the study by Te Rijdt et al.3 At the molecular level, the interaction of LC3 with p62 facilitates the fusion of autophagosomes with lysosomes during the degradation of protein aggregates or cell organelles. Notably, LC3-positive granules become larger in cells where autophagosome formation is abrogated.4 The first case concerns an annular elastolytic granuloma, a rare granulomatous skin disease of unknown etiology and pathogenesis, in which degraded elastic fibers are phagocytized by histiocytes and multinucleated giant cells. In this case, easily discerned asteroid bodies (Figure 1A) contained both p62 (Figure 1B) and granular deposits of LC3. The second case represents a foreign body-type granulomatous disease, in which granulomas had formed around abundant silicone material that had leaked from an elbow prosthesis into surrounding soft tissue (particle disease). In this case, many asteroid bodies were seen in the cytoplasm of multinucleated giant cells that had ingested the silicone rubber (Figure 2A). Here, asteroid bodies also contained both p62 and particularly large granules with LC3 (Figure 2B). Third, Figure 3 represents two different cases of cutaneous sarcoidosis, a disease in which Langhans-type giant cells with characteristic asteroid bodies usually are rare (Figure 3A). As in the other granulomatous inflammatory disorders presented herein, the asteroid body was surrounded by LC3-positive material (Figure 3B). In conclusion, ultrastructural studies published many decades ago have shown that the stellate shape of asteroid bodies is determined by the radial arrangement of a microtubular network around the so-called cytosphere. In this pilot study, IHC staining for the autophagy markers LC3 and p62 indicated that autophagy may play a role in the morphological appearance of asteroid bodies. For instance, it is conceivable that the dynamics of autophagy contribute to the bright red color of aggregated proteins around asteroid cores in hematoxylin and eosin-stained light-microscopic preparations. Moreover, given the remarkably large size of LC3-containing granules found in foreign body-type granulomas, it seems likely that autophagy may become impaired during a rapid cellular turnover when mononuclear histiocytes fuse into multinucleated giant cells. I have no problem concerning data sharing, including the complete text and all three figures.

Granulomatous annular diseases.

Granulomatous skin disorders comprise a large group of diseases that are typically characterized by granuloma formation both in the skin and in many other tissues. Cutaneous lesions are usually seen as erythematous papules and plaques that may occasionally be arranged in an annular, ringlike configuration. The etiopathogenesis is unclear in most cases, and granuloma formation may be associated with various systemic, infectious, and metabolic disorders, foreign bodies, environmental antigens, or malignancies. Treatment options are dependent on the etiology, extent, and severity of the lesions. This review includes the clinical, histopathologic, and dermatoscopy findings, differentials, and treatment options for noninfectious granulomatous annular skin disorders.

HISTO-PATHOLOGICAL SPECTRUM OF SKIN LESIONS IN TERTIARY CARE CENTRE: A THREE YEAR STUDY

Introduction: The largest sensory organ of human body is the skin, which accounts for about 15% of total body weight. It is a complex organ having multiple functions. Primarily it acts as a barrier against various harmful environmental agents (1).Skin diseases affect all age groups and are much common in developing countries. In the field of dermatology, 2000 different skin diseases are well known(2) Objectives: The objectives of the study were as follows: (1) To estimate the prevalence of various non-neoplastic and neoplastic skin lesions in our tertiary care hospital. (2) To study the age and sex-wise distribution of non-neoplastic and neoplastic skin lesions. Methods: The present study comprised a total of 102 skin biopsies of non-neoplastic lesions and neoplastic skin lesions, relevant data like age, sex, and sites of skin lesion were obtained from request forms provided to histopathology section. Specimens received were fixed in 10% formalin. Biopsy bits were submitted as whole and processed in automated tissue processor for routine paraffin embedding. Results: Out of 102 biopsies that were analyzed, most belonged to 21- 60years with slight male predominance with a total of 85 cases being Non-Neoplastic skin lesions, of which Chronic dermatitis 18 (28.5%) was the most common histopathological diagnosis, followed by Hansens disease 21(24.7%) among granulomatous skin disease, and a total of 17 cases of neoplastic skin lesions were identified of which dermatofibroma 2(11.8%) and eccrine spiradenoma 2(11.8%) were the benign variants , and Squamous cell carcinoma 3(17.6%) was the most common malignant variant. Conclusion: Histopathological evaluation of skin biopsies holds gold standard technique for diagnosing various skin lesions and their microscopic evaluation helps in assessing variegated morphological features of different types of skin lesions.

Clinical and pathological differential diagnosis of localised granulomatous skin lesions

Granulomas are focal infiltrates consisting mainly of macrophages or macrophage-derived cells (epithelioid, giant cells), chiefly in the case of impossibility or slow degradation of specific antigens. The variability of manifestations complicates the clinical and pathological diagnosis of granulomatous skin diseases due to individual patient reactivity and the specifics of often unidentified triggering factors. The mini-review analyses possible approaches to differentiating the most likely localised granulomatous lesions (granuloma annulare, sarcoidosis, tuberculides, leprosy, and lupus miliaris disseminates faciei) by providing recommendations on possible key clinical and histopathological characteristics. The review is illustrated by a case of a localized granulomatous lesion with features that are atypical but possible for some of the diseases discussed, with the most likely diagnosis of granuloma annulare (clinical course, localization, vertical infiltrates, destruction of elastic fibers, accumulation of mucin, solitary eosinophils). Pathologists need to consider different diagnostic approaches for different types of histological diagnoses, which may require opposite therapies. Therefore, the possibility of infection or foreign material in all types of granulomatous inflammation should be considered and PAS staining and polarized light microscopy should be recommended as basic steps in the examination. Special techniques such as Ziehl-Nielsen or Grocott methenamine silver should be also applied to identify the pathogen if necessary. It is essential to have enough tissue for histological examination, including immunohistochemical staining and polymerase chain reaction. Pathologists should not hesitate to ask for a larger tissue sample early in the disease if necessary. Keywords: tuberculoid granuloma, palisade granuloma, ring-shaped granuloma, granulomatosis of the skin, histochemistry, biopsy.

Dermoscopy of granulomatous and autoimmune skin diseases

Dermoscopy is an easily accessible, noninvasive diagnostic tool, originally used in the differentiation of benign and malignant skin tumors. Other structures beside pigment content observed by dermoscopy, e.g., scaling, follicles, or vessels, may present in aspecific pattern in different dermatoses. Recognition of these patterns may aid the diagnosis of inflammatory and infectious dermatological conditions. The aim of this article is to review the distinct dermoscopic features of granulomatous and autoimmune skin diseases. Diagnosis of granulomatous skin disorders is based on the histopathological examination. The dermoscopic picture of these diseases (cutaneous sarcoidosis, granuloma annulare, necrobiosis lipoidica, and granulomatous rosacea) show many similarities; however, there are some differences to note between the dermatoses, mainly in granuloma annulare. The cornerstones of the diagnostic process of autoimmune skin diseases (morphea, systemic sclerosis, dermatomyositis, cutaneous lupus erythematosus) include the clinical picture, immunoserology, and histology; however, dermoscopy may aid the diagnostic process and follow-up of the patients. For those diseases, where vascular abnormalities play an important role in the pathogenesis, videocapillaroscopy is used for examination of the microcirculation at the nailfold capillaries. Dermoscopy can be an easy-to-use everyday diagnostic tool in clinical practice regarding granulomatous and autoimmune skin diseases. Although punch biopsy is inevitable in many cases, the distinct dermoscopic structures can aid the diagnostic process.

CLINICO-HISTOPATHOLOGICAL CORRELATION OF GRANULOMATOUS LESIONS OF SKIN: A RETROSPECTIVE ANALYSIS OF 111 CASES

Introduction: Granulomatous skin lesions present as wide spectrum of clinical conditions where diagnosis with signicant accuracy is possible only through the histopathological examination of biopsy samples. The study was to a Aims and objective: ssess the frequency of granulomatous skin lesions and their pattern in relation to their clinical ndings and histopathology. The retrospective study was conducted Material & Methods: in the department of pathology of our institute. The data related to the age, gender, clinical presentation, and the biopsy ndings was analyzed. Results: Amongst 111 histologically proven cases of granulomatous lesions, there was male preponderance. The commonest age group involved was between 21-40 years. The common primary clinical types were plaque, nodule, and macule present in 42.34%, 31.53% and 15.31% cases respectively. The most common diagnosis was leprosy (54.05%), followed by tuberculosis (39.63%). Among the leprosy cases, borderline tuberculoid and borderline lepromatous were the most common types. Histologically, all lesions showed epithelioid cell granulomas, the commonest type being tuberculoid granuloma. This study reafrms that histopathology is Conclusions: a fundamental tool to diagnose granulomatous skin diseases. Type of granulomas, their pattern and associated features suggest about the diagnosis. Infective diseases (leprosy and cutaneous tuberculosis) are still the most common granulomatous skin diseases.

LB947 An open-label study of topical ruxolitinib in necrobiosis lipoidica

Necrobiosis lipoidica (NL) is a chronic granulomatous disease of the skin. A growing body of literature suggest that janus kinase (JAK) inhibitors for may be effective in the treatment of granulomatous skin diseases, including NL. Prior translational research identified activation of JAK-STAT pathways by interferon gamma (IFNγ) and other cytokines is integral to macrophage activation in these diseases. We aimed to evaluate the safety and efficacy of topical ruxolitinib, a JAK-1/2 inhibitor, for the treatment of NL.

Papular variant of actinic granuloma: a case report

Annular elastolytic giant cell granuloma (AEGCG) is an uncommon granulomatous skin disease characterized by giant cells in the dermis phagocytosing damaged elastin fragments, found mostly in areas that are more commonly exposed to sunlight. Asymptomatic annular plaques is the most common clinical presentation, although rare reports of a papular variant of AEGCG exist [1, 2]. We report a case of annular elastolytic giant cell granuloma papular variant with a history of allergies and intensive photodamage.

The Immunogenetics of Granulomatous Diseases.

Non-infectious granulomatous skin diseases are a wide category of well-defined reactive inflammatory conditions that share main similarities. While cutaneous sarcoidosis is the prototype of non-infectious (sterile) granulomatous dermatitides, there are several other entities in this group including granuloma annulare and necrobiosis lipoidica. Non-infectious granulomatous diseases are caused by complex associations between genetic situations and environmental triggers resulting in a variety of cutaneous and systemic manifestations. The genetic backgrounds of these diseases are the main topic of this manuscript.

Necrotizing Granulomatous Skin Disorder Caused by Accidental Injection of Oil Adjuvanted Chicken Vaccine Successfully Treated with Systemic Steroid Therapy

Necrotizing Granulomatous Skin Disorder Caused by Accidental Injection of Oil Adjuvanted Chicken Vaccine Successfully Treated with Systemic Steroid Therapy

Granuloma Annulare: An Updated Review of Epidemiology, Pathogenesis, and Treatment Options.

Granuloma annulare (GA) is an inflammatory granulomatous skin disease that can be localized (localized GA) or disseminated (generalized GA), with patch, perforating, and subcutaneous subtypes being less common variants of this benign condition. Recently, new research has emerged that further elucidates GA epidemiology and etiopathogenesis; importantly, new therapeutic options for GA have also been described, although there remains a paucity of randomized controlled studies. In this review, we summarize recent updates on GA epidemiology and etiopathogenesis and offer an updated review of the therapeutic options for GA currently reported in the literature. We hope that the current review galvanizes randomized controlled studies that will in turn help lead to the recommendation of evidence-based treatments for GA.

Pattern of granulomatous skin lesions in a tertiary care centre of western Uttar Pradesh

Granulomatous skin lesions frequently present as a diagnostic challenge to the pathologist because of various modes of presentation. Both infectious and non infectious causes lead to cutaneous granulomas. Histopathological diagnosis is required to confirm the clinical diagnosis and to classify the cutaneous granulomatous lesions. To study the spectrum, prevlance and frequency of various types of granulomatous skin diseases according to the age and sex of the patient. A cross-sectional type of observational study was carried out in the department of pathology, Rohilkhand medical college and hospital, Bareilly, Uttar Pradesh for the duration of 12 months (November 2018-October 2019). Punch biopsies received were fixed, grossed and processed, with the standard methods and were stained with hematoxylin and Eosin stain. All these biopsies were examined under the microscope and the slides in which granulomatous skin lesions were seen were selected for the study. Special stains were used wherever required. The data was analysed using SPSS version 22.0. Out of total 138 cases maximum number of patients belong to the age group of 21-40 years, with male preponderance. Infectious causes were the most common pathology leading to granulomatous skin lesions, with leprosy as the most common etiology.Leprosy is the leading cause of granulomatous skin lesions in this study. Skin biopsies are an integral part of evaluating cutaneous granulomas. Histopathology along with special stains are the gold standard in reaching exact etiology for a final diagnosis.

Een perioculaire vorm van necrobiosis lipoidica

A periocular form of necrobiosis lipoidica Necrobiosis lipoidica (NL) is an uncommon granulomatous skin disease of unknown origin. It is more often seen in patients with diabetes mellitus. Other cases describe an association with conditions like autoimmune thyroid disease, inflammatory bowel disease, sarcoidosis and rheumatoid arthritis. The skin lesions usually appear on the legs of the patient. Rarely, the disease presents in the face and/or scalp, in this case it is called “facial necrobiosis lipoidica” (FNL). When one or multiple annular, non-scaly plaques are observed in the face and/or scalp, it is important to think about FNL. The lesions are usually yellowish in the centre with areas of depigmentation and/or atrophy of the skin. In the periphery, the colour might be brown-red and sometimes an elevated border can be observed. FNL may look like another skin disease called “necrobiotic xanthogranuloma”. For this reason, histology is crucial for a correct diagnosis. It is important to exclude underlying diabetes mellitus. Necrobiotic xanthogranuloma is frequently associated with paraproteinemia. Therefore, this condition has to be ruled out by means of a blood analysis. There are no guidelines available for the treatment of FNL, but topical tacrolimus 0,1% might be an effective therapy for these patients.

Profile of Skin Biopsies and Patterns of Granulomatous Skin Diseases in a Tertiary Care Center of Western Nepal

Background: Granulomatous skin diseases are one of the leading causes of morbidity in tropical countries like Nepal. These granulomatous skin lesions often pose diagnostic challenge to clinicians as well as to dermatopathologists. Histopathologic examination of a biopsy specimen represents one of the most informative and cost-effective procedure and may help to avoid other, costlier and invasive diagnostic workup. 
 Materials and Methods: This cross-sectional observational study from October 2018 to October 2019, at department of dermatology, enrolled 142 cases of skin biopsies. Correlation between clinical impression and histopathological findings was evaluated. 
 Results: Out of 13940 dermatology visits/ consultations, 142 (1.01%) skin biopsies were performed. Head, neck and face were the commonest sites of biopsies (29.6%). The most common biopsy technique was incisional type in 70 (50.4%). Histopathology showed granulomatous features in 49 (34.8%) cases, out of which tuberculoid type was the commonest, in 29 (58.0%). Positive clinicopathological correlation was seen in 117/142 (82.4%) for all biopsies and 41/49 (85%) for granulomaous skin lesions. 
 Conclusion: Tuberculoid type was the most common cutaneous granuloma. High clinicopathological correlation in our study supports histopathology as an important tool for diagnosis of granulomatous as well overall skin disorders.

Sarcoidosis with necrobiosis-lipoidica-like skin lesions: A challenge for the dermatologist.

Necrobiosis lipoidica (NL) and cutaneous sarcoidosis are granulomatous skin disorders of unknown etiology. 1 Although these two diseases are distinct, they share histopathological and clinical features and, occasionally, one may mimic the other. 2 Only a few cases of concomitant NL and sarcoidosis have been reported. 3 Sarcoidosis is characterized by the formation of epithelioid and giant cell granulomas without caseous necrosis, and it may affect not only the skin but also many organs, most frequently (90%‐95% of cases) affecting the lungs. 4 , 5 Classic cutaneous lesions are erythematous papules, which become confluent forming a painless infiltrated plaque. 6 These lesions may be seen in any part of the body, especially on the face, superior chest and extensor face of the limbs. 7 In this report, a female patient, non‐diabetic, who was followed up along 20 years, presented different features of cutaneous sarcoidosis with no evidence of systemic invovement.