Skin nontumor
Granulomatous but noninfectious disorders

Author: Mowafak Hamodat MB.CH.B, MSc., FRCPC (see Authors page)

Revised: 25 October 2017, last major update July 2011

Copyright: (c) 2002-2017,, Inc.

PubMed Search: Sarcoidosis [title] skin

Cite this page: Hamodat, M. Sarcoidosis. website. Accessed July 23rd, 2018.
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

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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, non-caseating 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 trans-epidermal 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-positive inclusions, may be large lysosomes containing hemolipofuscin)

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

Images hosted on PathOut server:

Images contributed by Dr. Josehp Christopher Castillo Cuenca, Peru

Images hosted on other servers:

Various images

Asteroid bodies

Schaumann bodies

Hamazaki–Wesenberg bodies

Positive stains
Differential diagnosis