Skin inflammatory (nontumor)
Dermal granulomatous and necrobiotic reaction patterns

Topic Completed: 1 July 2011

Revised: 28 March 2019

Copyright: 2002-2019,, Inc.

PubMed Search: Sarcoidosis [title] skin

Mowafak Hamodat, M.B.Ch.B., M.Sc.
Page views in 2019: 14,075
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Cite this page: Hamodat M Sarcoidosis. website. Accessed January 24th, 2020.
Definition / general
  • Affects skin, lymph nodes and organs
  • Diagnosis of exclusion
  • Patients often have anergy to delayed hypersensitivity tests
  • May present with acute, self-limiting disease, as a chronic form exclusively affecting the skin or with a serious systemic variant with widespread lesions
  • Etiology is unknown
Clinical images

Images hosted on other servers:

39 year old man with systemic sarcoidosis

Cutaneous findings in systemic sarcoidosis

Microscopic (histologic) description
  • Inflammatory and granulomatous reactions with dense superficial and deep lymphocytes, eosinophils and plasma cells
  • Variable parakeratosis, spongiosis, acanthosis and epidermal erosion
  • May have lymphoid germinal centers resembling lymphoma with destruction of adnexae and atypia
  • Dense, noncaseating granulomatous infiltrate in the dermis extends into subcutaneous fat; granulomas are discrete and uniform in size and shape; composed of epitheloid histiocytes with abundant eosinophilic cytoplasm and oval nuclei containing a small central nucleolus
  • Variable Langhans giant cells, and scattered lymphocytes
  • Discrete, small central foci of fibrinoid necrosis are present; also transepidermal elimination
  • Also Schaumann bodies (calcium and protein inclusions inside of Langhans giant cells as part of a granuloma; basophilic laminated rounded conchoidal structures), asteroid bodies (small, intracytoplasmic, eosinophilic star shaped structure also present in tuberculoid leprosy, berylliosis and atypical facial necrobiotic xanthogranuloma), Hamazaki-Wesenberg bodies (peculiar PAS+ inclusions, may be large lysosomes containing hemolipofuscin)

  • Note: foreign material in sarcoidal granulomata does not exclude the diagnosis of sarcoidosis
Microscopic (histologic) images

Contributed by Dr. Josehp Christopher Castillo Cuenca

Various images

Images hosted on other servers:

Various images

Asteroid bodies

Hamazaki-Wesenberg bodies

Positive stains
Differential diagnosis
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