Sarkoidoza to wielonarządowa choroba ziarniniakowa o nierozpoznanej w pełni etiologii. U ok. jednej trzeciej pacjentów dochodzi do zajęcia skóry przez proces chorobowy. Zmiany skórne w części przypadków mogą stanowić jedyny objaw choroby. W jaki sposób się objawiają?
Zmiany skórne w przebiegu sarkoidozy mogą mieć charakter swoisty lub nieswoisty (odczynowy). Zmiany różnią się obrazem morfologicznym, rozległością oraz umiejscowieniem. Z tego powodu wyróżnia się wiele odmian klinicznych sarkoidozy skórnej.
Wśród zmian skórnych typowych dla sarkoidozy wymienia się: osutkę plamisto-grudkową, guzki podskórne, blizny naciekowe, lupus pernio (odmiana odmrozinowa choroby), tarczki, a także zmiany łuszczycopodobne, liszajowate, wrzodziejące, przypominające rybią łuskę oraz zmiany z obecnością przebarwień.
Do zmian nietypowych dla sarkoidozy należą natomiast rumień guzowaty oraz wielopostaciowy, zwapnienia, świąd oraz zniekształcenia płytek paznokciowych (palce pałeczkowate).
Rumień guzowaty
Rumień guzowaty to najczęściej występujący objaw sarkoidozy skórnej. Obraz kliniczny obejmuje słabo odgraniczone, zaczerwienione, ucieplone guzy w tkance podskórnej. Guzy powodują dolegliwości bólowe, ustępują najczęściej bez pozostawiania blizn, ale możliwe są pozapalne przebarwienia.
Sarkoidoza plamisto-grudkowa
W tej odmianie choroby występują niewielkie, nieznacznie nacieczone wykwity plamisto-grudkowe o czerwonobrunatnej barwie. Wykwity mogą ulegać zlewaniu i tworzyć większe ogniska, które często przybierają układ obrączkowaty.
Sarkoidoza obrączkowata
Objawem tej odmiany sarkoidozy są nacieczone blaszki, które rozrastają się obwodowo. Następnie zmiany ulegają zanikaniu w części środkowej, co może prowadzić do bliznowacenia i zniekształceń. Często są zlokalizowane w obrębie twarzy i karku oraz owłosionej skóry głowy, przez co mogą powodować łysienie.
Sarkoidoza guzkowa
W obrazie klinicznym obserwuje się czerwonobrunatne guzki o różnej wielkości i lokalizacji. Szczególną postacią sarkoidozy guzkowej jest postać odmrozinowa (lupus pernio). Występuje ona zwykle w późnym stadium choroby. Przybiera postać naciekowych zmian o sinofioletowej lub czerwonej barwie, które są umiejscowione przede wszystkim w obrębie twarzy. U niektórych chorych mogą występować również na palcach rąk. Jeżeli zmiany rozwiną się w obrębie nosa, może dojść do zajęcia błon śluzowych i kości, a w konsekwencji do rozpadu i perforacji przegrody nosowej.
Sarkoidoza naczyniowa
Głównym objawem tej odmiany sarkoidozy skórnej są czerwonobrązowe grudki, guzki i blaszki z licznymi teleangiektazjami. Zmiany są zlokalizowane przede wszystkim w obrębie twarzy.
Sarkoidoza wrzodziejąca
W przebiegu sarkoidozy skórnej może dojść do rozwoju ognisk sarkoidalnych w obrębie podudzi. Zmiany ulegają rozpadowi i mogą powodować znaczne trudności w gojeniu. W tej odmianie choroby zmianom skórnym towarzyszą zwykle zmiany układowe.
Zmiany sarkoidalne w bliznach
W przebiegu sarkoidozy może dojść do rozwoju ognisk sarkoidalnych w bliznach różnego pochodzenia, w miejscach po zrobieniu tatuażu oraz makijażu permanentnego lub w miejscach, gdzie wprowadzone zostały wcześniej ciała obce. Zajęty chorobowo obszar skóry staje się zaczerwieniony i nacieczony.
Źródło:
- M. Błaszczyk, „Sarkoidoza skórna – różnorodność kliniczna i trudności diagnostyczne”, „Przegląd Dermatologiczny” 2012, 99: 185-194.
- A. Dubaniewicz, „Sarkoidoza – choroba o wielu twarzach”, „Forum Medycyny Rodzinnej” 2009, 3(1): 27-41.
- M. Ali, A.A. Atwan, M. Gonzalez, „Sarkoidoza skóry: najnowsze dane dotyczące patogenezy”, „Dermatologia po Dyplomie” 2010, 1(6): 50-61.
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