Dear Editor, Sarcoidosis is a multisystem granulomatous disorder that has been documented at sites of previous scarring due to tattoos, laser surgeries, axillary electrolysis, venepuncture, herpes zoster scars, acne, hyaluronic acid injections, and many other modes of microscar formation. In about one-third of cases of sarcoidosis, skin lesions are the initial manifestations of a systemic illness. A 52-year-old lady presented to the dermatology outpatient department with complaints of multiple asymptomatic skin eruptions of 6 months’ duration, which she had developed after performing waxing of both the forearms and hands. The lesions started one-month post-waxing, and continued to persist despite the topical application of emollients and steroids prescribed by a local doctor. She did not complain of any systemic symptoms in the form of joint pains, cough, chest pain, breathlessness, allergies, or an evening rise in temperature. On dermatological examination, she had multiple tiny grouped non-pruritic, non-tender shiny skin-colored to violaceous papules located symmetrically over both forearms, extending up to the elbows on both dorsal and ventral surfaces [Figure 1]. Examination of the scalp revealed an asymptomatic atrophic alopecic plaque which had an onset 5 years back in the form of a red itchy plaque that had subsided on its own without further increase in size or hair growth in the area. Examination of the right eye showed mild redness due to which an ophthalmological consultation was taken. Ocular examination showed the presence of mutton fat keratic precipitates in the anterior chamber of both eyes [Figure 2]. Dermoscopy (X10, Illuco) showed multiple follicular and non-follicular papules with a central hub (central white area) surrounded by brown lichenoid dust (greyish brown granules) [Figure 3]. Histopathology revealed orthokeratosis, focal hypergranulosis, follicular plugging, basal cell vacuolation and melanin incontinence. The reticular dermis showed well-formed epithelioid granulomas with multiple Langhans-giant cells and few surrounding lymphocytes (naked granulomas) along the neurovascular bundles [Figures 4a and b]. The granulomas showed positivity for reticulin stain [Figure 4c]. A skin biopsy from the alopecic patch on the scalp also showed well-formed epitheloid granulomas which were positive for reticulin stain. Based on the above findings, a pulmonary evaluation was done. The pulmonary radiograph showed multiple subcentimeter-sized nodules scattered in bilateral lung fields [Figure 5a]. High-resolution computed tomography (HRCT) chest showed multiple discrete and conglomerate lymph nodes seen in prevascular [Figure 5b], pretracheal, bilateral paratracheal, and bilateral hilar areas. Complete blood count, hepatic and renal functions, and blood sugar levels were normal. The serum angiotensin-converting enzyme value was 75 IU/L (normal levels <40 IU/L). The Mantoux test was negative. Based on the above clinical, histopathological, and radiological findings, a diagnosis of sarcoidosis was made. A pulmonology opinion was taken, and the patient was started on oral steroids, oral hydroxychloroquine, and topical super potent corticosteroid for skin lesions. She responded very well to the treatment with improvement in the skin lesions [Figure 6].Figure 1: Multiple tiny grouped non-pruritic, non-tender shiny skin colored to violaceous papules located symmetrically over both forearms extending up to the elbowsFigure 2: Ocular examination showed the presence of mutton fat keratic precipitates in the anterior chamber of both eyes (black arrow)Figure 3: Dermoscopy (10x, Illuco, polarized) showed multiple follicular and non-follicular papules with a central hub (central white area) surrounded by brown lichenoid dust (greyish-brown granules)Figure 4: (a) Histopathology (H and E, 40 X) showing well-formed epithelioid granulomas with multiple Langhans giant cells and few surrounding lymphocytes (naked granulomas) along the neurovascular bundles. (b) Histopathology (H and E, 40 X) showing the presence of Schaumann bodies (black arrow). (c) Histopathology (H and E, 40 X) showing granulomas with positivity for reticulin stainFigure 5: (a) The pulmonary radiograph showed multiple subcentimeter-sized nodules scattered in bilateral lung fields. (b) HRCT chest showed multiple discrete and conglomerate lymph nodes seen in the prevascular areaFigure 6: Resolution of the multiple tiny grouped non-pruritic, non-tender shiny skin-colored to violaceous papules located symmetrically over both forearms after treatmentSarcoidosis is a non-caseating granulomatous disease involving multiple organ systems.[1] The disease pathogenesis involves microbiologic, genetic, and environmental factors and triggers that activate immune reactions.[2] Cutaneous lesions in sarcoidosis have no prognostic significance and do not correlate with the extent of systemic involvement.[3].In this case, the lesions were precipitated by hair removal by waxing. Lichenoid sarcoidosis is a rare variant of cutaneous sarcoidosis presenting as grouped yellowish to skin-colored pinhead size lesions which commonly involve the trunk, limbs, and face.[4] The dermoscopy findings usually reveal circular or oval yellowish-brown lesions with the absence of Wickham’s striae, with whitish radiating spikes which were absent in this case.[5] In addition to the central white hub, dark granular dots were seen (a finding seen in lichen amyloidosis) in this case. The differential diagnoses of lichen amyloidosis and lichen scrofulosorum were ruled out due to the presence of well-formed granulomas on histopathology and negative tuberculin skin test, respectively. Treatment approaches for such patients include oral and topical corticosteroids, azathioprine, methotrexate, thalidomide, allopurinol, isotretinoin, and topical calcineurin inhibitors.[6] We aim to highlight the importance of considering cutaneous sarcoidosis as a differential diagnosis of skin lesions developing at the sites of trauma. Though cases of scar sarcoidosis have been reported in large numbers in literature, we aim to report that superficial and trivial trauma such as waxing can also lead to cutaneous sarcoidosis. Patients with sarcoidosis should be counseled aboutsuch complications. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.