Two clinical cases of sarcoidosis of the skin are presented in combination with intragenuous lesions. It is shown that the use of antimalarial drugs, glucocorticosteroids and methotrexate is effective in such patients, which is expressed in the positive dynamics of skin changes, intragenic lymph nodes and lungs. It is noted that the dynamics of skin lesions during sarcoidosis often corresponds to the dynamics of intragenic changes and serves as an indicator of the effectiveness of therapy.

Sarcoidosis - epithelioid-cellular non-zerifantic granulomatosis of the unknown nature - remains the subject of discussion of specialists from various fields of medicine. In Russia, where this disease has become the object of attention of pulmonologists, therapists and general practitioners, the diagnosis and treatment of sarcoidosis is very relevant. In the Republic of Tatarstan, assisting patients with sarcoidosis is regulated by the Order of the Republican Ministry of 2010, according to which the diagnostic process is optimized with the participation of the Republican clinical Hospital, oncological and phthisitric services. The register of sarcoidosis patients in Tatarstan at the time of writing this article has 1655 patients. Work is carried out to increase the level of knowledge of doctors about sarcoidosis, they are also recommended to acquaint tutorialAvailable on the website of the Russian respiratory society. Due to the increase in literacy, sarcoidosis doctors began to identify not only according to the results of fluorographic studies (in phthisiarty and pulmonology) or the symptom complex of Lötgren syndrome (mediastal lymphadenopathy, nodal erythema, arthritis and fever - in rheumatology), but also in the skin and visceral signs of this granulomatosis.

Skin lesions occurs almost every 3rd patient with systemic sarcoidosis. The prevalence of various types of skin lesions varies both between races and between individual individuals. In Russia, the frequency of skin lesion during sarcoidosis, according to the clinics, which is observed with patients with pulmonary and systemic sarcoidosis, is 22.5% of cases, while according to dermatologists - 63.4%. Skin lesions can be the first observed manifestation of the disease. Specifically for sarcoidosis knots, plaques, maculo-papular changes, Lupus Pernio, scar sarcoidosis. Rare manifestations include lihenoid, psoriazoidal changes, ulcers, angolaupoid, ichthyosis, alopecia, hypocygnituted spots, nail damage and subcutaneous sarcoidosis. Sarcoidosis can also manifest themselves annular, indurative plaques (Granuloma Annulare). The lesion of the skin during sarcoidosis is regarded as specific if the biopsy detects non-zeesifying granulomas, and nonspecific - with noded erytheme. Skin biopsy allows you to quickly diagnose sarcoidosis with a minimally invasive procedure. Skin lesions are prognostic. Lötgren syndrome is usually accompanied by a good forecast and spontaneous remission. Maculo-Papulse Changes and subcutaneous components are most often accompanied by spontaneous remission for two years, while plaques and especially "chill-free lupus" are signs chronic disease. Most skin lesions have moderate symptoms and do not require treatment. However, chronic skin lesions, especially Lupus Pernio, lead to the disfigurement of a person and have a strong psychological and social impact. Treatment of such changes is a problem, since such patients do not always respond to generally accepted therapy. Nevertheless, the description of certain cases is indicated by the coarableness of sarcoidosis of the skin localization. So, in a 28-year-old woman, in which sarcoidosis was manifested itself with purple plaques on the face, the treatment with hydroxychlorochino 200 mg 2 times a day for 3 months did not lead to full resolution of changes, only prednisone at a dose of 1 mg / kg, followed by a decrease in dose in For 5 weeks provided remission and lack of recurrence for 6 months of observation. In a 52-year-old patient with multiple skin lesions, three-week therapy with hydroxychlorochine with low doses of prednisolone was sufficient to resolve changes. In a 15-year-old boy with isolated sarcoidosis of the skin, a combination of hydroxychlorochin with local use of fluticasone was effective - a complete resolution of the skin manifestations after 4 months was marked.

We present two clinical cases of the skin-proved skin level in combination with intragenuous lesion.

Clinical case 1.

In the patient A., 49 years old, with the next fluorographic examination, bilateral dissemination was discovered. The patient had no complaints. In an objective study, prescription lymph nodes were placed. Breathing was vesicular, wheezing did not hear. Changes of skin, eye lesions and joints were not detected. The patient was sent to the anti-tuberculous dispensary. The Mantu reaction was positive - papula 16 mm (2 tuberculin units (those) purified tuberculin (PPD-L)), acid resistant mycobacteria (cum) were not detected in sputum. The disseminated tuberculosis of the lungs was assumed and a complex anti-tuberculosis drug Mairin-P was assigned (isoniazide + pyrazinamide + rifampicin + ethambutol). After 2 months, the clinical effect of treatment was absent, and after the phthisitric commission, anti-tuberculosis therapy was canceled, the diagnosis of Sarcoidosis was made, the patient was aimed at the pulmonologist. Repeated tuberculin test was negative, Kum were not found. The function of external respiration did not suffer (the forced life capacity of the lungs (freak) amounted to 125%, the volume of the forced exhalation in 1 second (OFV₁) is 127% of the proper values), the diffusion capacity of the lungs by carbon oxide (DLCO) - 125% of the due. In a clinical analysis of blood: EE 8 mm / hour, leukocytes 7 × 10⁹ / l, lymphocytes in leukoformula - 31%. Ultrasound procedure (Ultrasound) organs abdominal cavity Pathology did not reveal. With X-ray computed tomography (RTC) organs chest There was a dissemination in combination with interstitial changes (Fig. 1). With careful inspection, limited changes in the scalp (Fig. 2) and the body were revealed. A skin biopsy has been carried out, which discovered chronic granulomatous inflammation of sarcoid type. A final clinical diagnosis was set: "Sarcoidosis of internal lymph nodes and light, peripheral lymph nodes and skin." Given the large volume of lesion and polyorganity, the treatment with systemic steroids was planned from which the patient refused. Alternatively, Pentoxifillain was prescribed 0.2 g 3 times a day and vitamin E of 200 mg 2 times a day. After 8 months of this therapy, the patient felt satisfactory, but the skin changes remained unchanged. When carrying out an RTI in the dynamics, the picture was noted - an increase in the number of foci in the lungs, multiple foci in Plegre (Fig. 3). The respiratory function remained within the normal range, but the dynamics was negative (Ferro 103%, of the FE 105% of the proper, DLCO 117% of due). Prednisolone was prescribed in a daily dose of 30 mg (morning - day) and Vitamin E. After 6 months of therapy, the skin manifestations were held, according to the RT-picture, a positive dynamics was achieved (Fig. 4). To this moment daily dose Prednisolone remained 10 mg. However, steroid therapy was accompanied by such phenomena as an increase in body weight (from 79 kg to 94 kg), a decrease in visual acuity, destruction of teeth. After 3 months, treatment prednisone (course 9 months) was completed, but at that time weakness appeared, changes on the skin of the head, testifying to the beginning of the exacerbation after the abolition of prednisolone. The patient was invited to hold therapy by Methotrexat, but he refused, and he was launched a repeated course of steroid therapy.

Clinical Case 2.

Patient K., 41 years old, was revealed when contacting the therapist about weakness progressive skin changes. Seborive dermatitis was diagnosed, but the skin changes became rude (Fig. 5); The patient was sent to the oncologist, which in a short time made a biopsy of the skin and revealed non-zeesifying epithelio-cell granulomas with giant multi-core cells. Sarcoidosis of the skin was diagnosed ("Languaged Volchanka"). There were no complaints from the side of the lungs, the breath was tough, but wheezing did not hear. In the RTC, increased intragenic lymph nodes were revealed more than on the left (Fig. 6). The parameters of the spirometry were within the normal range (Fire 87.5%, the FE 90.9% of the proper). There were no changes in the hemogram, the total Ca of the blood was 2.09 mmol / l. Functional liver tests were normal. The patient suffered from type 2 diabetes, obesity, hypertensive disease, which made the use of glucocorticosteroids unsafe. The patient was discussed to the tactics of further therapy, it agreed to the use of cytostatic drugs, and it was appointed Methotrexate 1 time per week inward: in the first week 5 mg, in the second - 10 mg and from the third week and further - 15 mg for a period of 6 Monthly monitoring of the number of leukocytes and peripheral blood lymphocytes, as well as the activity of alanine and aspartatenotransferase for the early detection of undesirable phenomena of methotrexate. Patient treatment was fine. By the fifth month, the change on the skin was completely disappeared. Radiographs remained moderate mediastinum lymphadenopathy.

Conclusion

These literature and the results of their own observations indicated the great practical significance of the recognition of skin manifestations of sarcoidosis and verification of polyorgan lesion using a low-alimony procedure - skin biopsy. Antimoraric preparations, glucocorticoids and methotrexate remain perspective methods of skin forms of sarcoidosis. It is noted that the dynamics of skin lesions during sarcoidosis, as a rule, corresponds to the dynamics of intragenic changes and serves as an indicator of the effectiveness of therapy.

Sarcoidosis of the skin is a systemic disease of unknown etiology, morphologically characterized by epithelioid cell granulomatous structure without caseous necrosis. It is considered as a reactive pathology, which is a leading role in the development of which plays an unusual answer. immune system For a number of different factors (infections, including tuberculosis, allergens, chemical stimuli, endogenous antigens, etc.).

The presence of cases of sarcoidosis in twins testifies to the genetic predisposition to this disease. In these patients, as a consequence of the disease, there is a decrease in the blood content of T-lymphocytes with the predominance of suppressors, an increase in lymphocytes.
With sarcoidosis of lesions of the skin, characterized by clinical polymorphism, are observed in 10-30% of cases. They can be specific and nonspecific, combined with the damage in the internal organs or be isolated.

Nonspecific rash (nodular erythema) is often combined with the damage to the internal organs, and the specific one is observed only in 6-10% of patients with sarcoidosis. There are typical (classic) and atypical skin sarcoidosis forms. Typical include:

• sarcoidosis of beck
• tennes-Tennes Wolved
• angolaupoid Broca-Voice,
• subcutaneous sarcoidosis Darius-Russi.

Three types are isolated sarcoidosis Beck: Fineless, in the form of large nodes and diffuse-infiltrative.
Smallless sarcoid It happens more often than other varieties. Multiple, symmetric, pink-red spots are gradually transformed into the nodules, arise with groups, separate flashes in a few days, are clearly excluded, the value from 1-2 mm to 0.5 cm, semi-odd, with a smooth surface, pale pink or brick- of red color. On the surface of large elements there may be teleangectas, peeling. Diacopy detects yellowish spots (dust phenomenon). Elements can be ductoid and reminded red flat deprived. The nodules are arranged in isolated or groups on any areas of the skin, but more often perioral and periorubital. They may not change for months and years, but then aggravation comes with the appearance of new nodules. In the regression stage, the nodules become flat, west, the number of teleangectasis, scales increases, the color changes to the yellow-brown, brown.

Sarcoid in the form of large nodes Localizes mainly on the forehead, nose, cheeks, neck, upper limbs. The nodes of the magnitude of the pea to the walnut are clearly deliberate, protrudes over the skin level, semi-like, less often flat, dense, with a smooth surface, telegangectasia and milium-like elements, rarely with peeling. They are red, dark cherry, subsequently yellow-brown, purple, brown, positive dyesome phenomenon, do not cause subjective sensations and very rarely disintegrate, few, with hard flow and resistant to therapy. Recession begins with the center for the development of ware, on the periphery, an infiltrated roller is observed. Subsequently, hyper-or depigmentation, telegangectas, scar atrophy remains at the site of the node.

Diffuse- infiltrative sarcoid Frequently combined with the above-described forms. There are large, fuchly outlined, purple-red, purple-pink, blue-brown infiltrated plaques with a smooth surface, more often on the face, but they can occur on the scalp, neck. They increase, they can merge up to the development of erythrodermia, they do not enter the subjective sensations, there are months and years, hyperpigmentation, telegangectas, scar atrophythia remain on the site of the reverse development of plaques.

Lupus Bone-Tennes It develops more often on the face (cheeks, nose, localization of the "butterfly"), the back surfaces of the brushes and fingers from the appearance of small erythemical infiltrated elements with a smooth surface, inclined to the peripheral growth and the formation of large foci of incorrect outlines with erased contours, amplification of infiltration, color change to Blue-bug, purple, brown. In developed cases, foci purple-brown, in the form of plaques, nodes with a smooth surface, telegangectasis, extended follicles. Sometimes there is a positive dancer of dustiness, less often - insignificant itching, soreness. Fingers can take a spind-shaped form, it is possible to decay in the center of foci to form significant defects with granulation and purulent-bloody discharges. In half of the patients, synovial and bone finger cysts are formed, during localization on the scalp, the development of scar atrophy and alopecia is possible. Simultaneously, patients may have lesions of nasopharynx, larynx, nose bones.

Angolaupoid Brock-Cleanlocalizes in the area of \u200b\u200bthe nose in the form of a single plaque. At first, it is a round spot of blue-pink color with telegangectasia on a smooth surface, which for weeks turns into a round or oval plaque with clear contours, a soft consistency of purple-red color, which then becomes yellow-brown, brown, on the surface there are many telangectasius on the surface. The diameter of the plaques reaches 1-2 cm, the positive phenomenon of dustiness, subjectively there is a slight itching or soreness. In this state, the plaque exists for months, less often - years.

Hypodermal Sarcoid Daria-Russa It is rarely rare in the form of single or multiple subcutaneous dense moving nodes of 1-3 cm, the skin over which is not changed or blue. Subsequently, it connects to the nodes and resembles the skin of the orange, the nodes can merge, but do not disintegrate. Typical localization - hips, lower abdomen. When palpation sometimes observes small pain. Long, long-term.

Atypical Forms sarcoidosis:

• psoriazo-like
• ichthyozoomy
• sclerodermoid
• warty,
• ulcerative
• spotted,
• pyatnost-Papulse Sarcoid.

Differential diagnosis is required with sarcoma, basaloma, warts, red lupus, seborrheic eczema; Questions solves histological research. Perhaps an isolated or combined (with skin damage) damage to the mucous membranes.

Non-specific lesions of the skin during sarcoidosis are found in 1/3 patients in the form of nodular erythema, more often in women, and indicate an acute version of sarcoidosis, which is accompanied by:

• fever
• ailment
• arthralgia
• uvetit
• acceleration ESO,
• bilateral roasting lymphadenopathy (Sidrode Lefgrön).

He proceeds benign, in 80% of cases, recovery comes without treatment.

How to treat skin sarcoidosis?

Basic B. treatment Sarcoidosis of the skin It is a long, up to six months or more, the use of glucocorticosteroids, taking into account organ lesions. The initial dose of prednisolone is usually 30-40 mg per day with a gradual decrease to a supporting dose.

Advocative combination of corticosteroids with cytostatics, among which methotrexate, azathioprine, recidencies. Antimalyariy drugs are used - delagil, Plaquened. In cases of limited lesions, there is enough intrality administration of corticosteroids, the use of corticosteroid ointments at the occlusion site, which lasts, however, for several months.

It is noted that after a long flow of the process, a spontaneous recovery is observed with sarcoidosis patients with sarcoidosis, especially in cases of acute sarcoidosis in women. Chronic, the protracted process of the process requires active therapy.

What diseases may be connected

Sarcoidosis of the skin is primarily an indication for examination of the patient for the presence of a given disease of lung or bone localization. The lungs or sarcoidosis of the bones in its etiology contains the same factors as sarcoidosis of the skin, they often turn out to be idiopathic, and sometimes hormonally or genetically determined.

The disease adopted for sarcoidosis of the skin can actually turn out to be lymphoma, mastocytosis, xantomatomy, ring-shaped granuloma, since their symptoms are similar. The presence of appropriate manifestations requires laboratory diagnostics within the professional approach.

Treatment of skin sarcoidosis at home

Treatment of skin sarcoidosis It often passes at home, but the need to consult with the attending physician is not canceled. Often the disease is not local, but systemic character and affects, for example, and the lungs, among other things. Treatment at home requires the fulfillment of all medical prescriptions. It will not be superfluous and compliance with a certain regime, maintaining healthy image Life. There are, for example, recommendations on the diet of the diet:

• it is necessary to limit consumption
  • refined sugar,
  • flour
  • cheese
  • milk and dairy products,
  • salty salt
  • alcohol;
• enable in the menu:
  • honey,
  • nuts
  • sea \u200b\u200bbuckthorn and black currant
  • marine cappist
  • grenades
  • beans
  • basil.

What drugs to treat skin sarcoidosis?

Recovery is possible without use medicinal preparationsHowever, if the attending physician considers it necessary to assign the therapy, the choice falls on glucocorticosteroids, the definition of the names and dosages of which requires an individual approach in this case. They are sometimes combined with cytostatics, among which Methotrexate, Azatioprin, Pospidnin.

Treatment of skin sarcoidosis by folk methods

Treatment of skin sarcoidosis It can occur through folk drugs, but this does not guarantee sufficient effect. The use of any of the following recipes is better to discuss with your attending physician, and in the absence of a result or exacerbation of symptoms and to abandon its use at all:

• propolis tincture - 50 ml of 70-degree alcohol to connect with 10 grams of crushed propolis, put in a glass container, clog and leave in a dark place for 2 weeks, to periodically shake; obtained tincture to process the resulting skin defects;
• lilac tincture - 1/3 glasses of freshly collapsed lilac flowers place in a glass jar, pour 200 ml of high-quality vodka, mix thoroughly, close, leave for 7-8 days, periodically shake; After the designated period of infusion to strain and use for rubbing into the affected areas of skin, as well as to the lung area, if the appropriate diagnosis is set;
• the decoction of herbs is to connect an equal amount of soul, plantain, dispatch, sage, calendula flowers, altea root; 1 tbsp. Gathering to place a thermos, pour the glass of boiling water, insist within an hour, strain; Use for compresses and applications.

Treatment of skin sarcoidosis during pregnancy

Sarcoidosis of the skin is not a contraindication to the occurrence of pregnancy, moreover, it is noted that due to hormonal perestroika, pregnant women can weaken and move into the remission stage. By the way, the sarcoidosis of the lungs is also not an obstacle for pregnancy and the birth of a healthy child. However, if the latter causes the risks of the development of pulmonary fibrosis and hypoxemia with a further occurrence of the pulmonary heart and hypertension, the localization of sarcoidosis is not saccidosis exclusively on the skin, and therefore the skin sarcoidosis is not at all an indication for interrupting pregnancy.

It should be noted that the pregnancy planning for the sarcoidosis of the skin of a woman should include radiography of the lungs, laboratory tests (general blood test, hepatic enzymes, creatinine, whey calcium, nitrogen in the urine), study of the external respiratory function to eliminate the likelihood of localization of the disease in the internal organs. If medications are prescribed for pregnant women treating sarcoidosis of the skin (which is determined by the attending physician), then the choice will fall on those that do not have a side effect on the fruit.

With caution, it is necessary to refer to the use of vitamin D, which partially provokes the development of hypercalcemia in patients with sarcoidosis of women.

Treatment and treatment control and a dermatologist, an obstetrician-gynecologist and, if necessary, a pulmonologist.

What doctors to contact, if you have skin sarcoidosis

The diagnosis of sarcoidosis of the skin is based on clinical and histological symptoms, biopsy of peripheral lymph nodes.

Laboratory indicators for skin sarcoidosis are as follows:

• raising the level of ACE
• hypercalciuria
• improving alkaline phosphatase and hydroxyproline,
• leukopenia
• hyperchromic microcolist anemia
• eosinophilia,
• hypergammaglobulinemia,
• acceleration ESO.

Granuloma without caseous decay, consists of epithelioid cells, among which are observed by the giant Langhanes cells and the cells of foreign bodies; Around the granuloma - lymphocytes, macrophages, fibroblasts, in its center - sometimes fibrinoid necrosis, and in the cytoplasm of giant cells - calves (inclusion) of shauman, asteroid and residual calves.

Advocative Differential diagnosis with lymphomas, sarcoma capos, mastocytosis, xanthomatomy, systemic red lupus, ring-shaped granuloma.

Treating other diseases on the letter - with

Skin covers are affected by 25% of patients with sarcoidosis. Usually this symptom accompanies systemic manifestations of pathology, but in some cases skin signs are the only manifestation of the disease. With sarcoidosis in the tissues, special non-disintegrating nodules are formed - granulomas that may arise in any area, including on the skin.

The first case of the disease was described back in 1869, but its reasons are still unknown. Other signs of pathology is the formation of granuloma in 90-95% of patients, which determines the disease forecast. Lymphatic nodes are also affected (especially ingenious), eyes, liver, heart, nervous system, musculoskeletal system, nervous and endocrine systems. In some cases, sarcoidosis is spontaneously cured.

Causes of the disease

The exact cause of the disease remains unclear. However, there are some risk factors - the female floor, a non-Christian race, as well as a significant impact of hereditary predisposition.

Pathology is very rarely striking children, and the first symptoms usually arise aged 20-40 years.

What is skin sarcoidosis?

This is a chronically current inflammatory disease, affecting predominantly skin and light, causing a variety of skin symptoms. It is not contagious. As a result, there are either scars on the skin, or all manifestations spontaneously disappear, but it is impossible to predict the outcome.

External manifestations

Skin classification includes nonspecific and specific. Specific lesions are characterized by the formation of nodules - granuloma, while with histological examination of nonspecific changes in the granuloma.

Basic nonspecific defeat Sakcoidosis skin - noded erythema. Specific forms include:

• chopped lupus;
• maculopapulous;
• nodal;
• scar;
• flat;
• angolaupoid;
• ichthyazoform;
• lihenoid;
• wart;
• psoriazo-like;
• ulcery;
• subcutaneous nodules.

Sarcoidosis of the skin in children can be hereditary or arising sporadically. The disease is caused by the mutation of the NOD2 gene and is associated with autoimmune processes. There is such pathology in early age. Granulomas are striking skin fabrics, joints and an intense path of the eye.

Journal Erythema

Is an enhanced skin reaction in response to the action of various infectious agents (Especially streptococci), drugs (including oral contraceptives) and with systemic diseases, in particular, sarcoidosis. Usually it occurs suddenly and spontaneously disappears, but prone to relapses.

Red-free painful nodes are most often located on the front surface of the lower leg. They may be accompanied by fever, joint pains and poor well-being. Usually the young women suffer.

Often, narrowing erythema appears in the case of acute development of pathology. It is a favorable forecast marker, that is, the high probability of spontaneous cure. At the same time, the treatment of hormones are not prescribed.

They are contrasting specific sarcoid defeats, since it can be observed in many other diseases, primarily with tuberculosis, yersiniosis, crown diseases and behcheta, streptococcal infection, pregnancy. It can cause sulfonamide, oral contraceptives. With sarcoidosis, this form is combined with the damage to the intrathoramic lymph nodes, fever, pains in different joints, the appearance of signs of inflammation in blood tests. In this case, they are talking about lefgren syndrome - acute version of sarcoidosis.

Despite the nonspecific nature of the lesion, the nodal erythema is most often observed in sarcoidosis, and is the most frequent skin manifestation. With the appearance of such a lesion, it is necessary to conduct radiography or CT of the chest. Biopsy in this case is not assigned.

Oznobled Volchanka

The most indicative, but also one of the rarest, lesions of the skin during sarcoidosis. It is characterized by the appearance of red, purple or purple dense plaques or nodules. Usually, sarcoidosis of the skin of the face is manifested when the nose, cheeks, ear sinks and lips are affected. However, the elements of the rash can occur on the hands, fingers of the brushes and stop, less often on the forehead, in rare cases on the walls of the nasopharynx and larynx, make it difficult to breathe.

Such a defeat is more often observed in people with long-hazardous sarcoidosis, it is often accompanied by an uveitis, an increase in the internal organs, sarcoidosis of the upper respiratory tract and the formation of bone cyst (cavities). The current is usually chronic, poorly perfectful therapy. As a result of the process, a persistent cosmetic defect may occur, right up to the disfigurement of the face.

Oznogenic lupus is a sign of an unfavorable course of the disease with a rapid defeat of the internal organs.

Frequently found form, which is sarcoidosis of the scalp. The defeat does not cause complaints. Outwardly, it resembles the spots of red-brown color, located on the face, around the eyes, in nasolabial folds. Significant surfaces of the joints can also be affected.

After disappearance, the stains are often formed by the scars. The defeat is most characteristic of acute sarcoidosis.

The symptoms of the flat shape of sarcoidosis of the skin are manifested in the following:

• plaques round or oval shape of red-brown color;
• the elements of the rash penetrate the skin, their center can be atrophied;
• sometimes the plaques are peeling, and in this case they can be taken for manifestations of psoriasis or;
• the limbs are affected, face, the scalp, spin, buttocks;
• suffer symmetric skin sections;
• sometimes plaques acquire a ring-shaped form.

Angolaupoid form manifests itself very similar, but on the surface of the plaque, there are additionally extended vessels - teleangioectasy. This is an extremely rare form.

The process involving the skin is chronic, as a result, scars can be formed. During the damage to the scalp, the bald sections arise. With this form of pathology, as a rule, there are systemic lesions, first of all, the lungs.

Papulse and Blossar Options - Signs chronic flow Diseases or its exacerbations, as well as they arise when engaging new organs, for example, heart or joints.

Subcutaneous nodules

Subcutaneous nodule sarcoidosis is also called Darnier-Russi's disease. Defeat, as a rule, painless, oval shape, bodily or purple color. The nodules have a size of 0.5-2 cm in diameter and found on the limbs and torso.

Usually they arise in the debut of the disease, in the absence or easy severity of systemic lesions, as well as with exacerbation of the disease. In some patients, the nodules are spontaneously permitted.

Other lesions

Sarcoidosis of the skin is called the "great pretender", as it can manifest itself with almost any elements of rash. It can resemble, lihenoid defeat, vasculitis, psoriasis, warts and skin ulcers.

Separations of the skin surface with scars and scars obtained earlier as a result of injuries, operations or, for example, tattoos can suffer. Their infiltration and seal occurs, as well as color change. This feature is quite specific. For example, a change in any former color of tattoo on red or purple is one of the diagnostic signs. The so-called revived scars - a sign of aggravation of the disease.

Sometimes the tattoo itself provokes a granulomatous reaction and infiltration by sarcoid formations. At the same time, the systemic manifestations of the disease do not arise.

The ichthyazoform version is often diagnosed by chance. It is always combined with the defeat of the lungs, eyes and other organs.

In the ulcerative type, either the formation of skin ulcers as the primary sarcoid element on the intact skin occurs, or the formation of a granuloma in existing skin ulcers of another nature, for example, with varicose veins.

Sarcoidosis (Beck-Beka-Shaumanna disease)

Diagnosis and Differential Diagnostics

A list of diseases that need to be distinguished from skin sarcoidosis:

• addiction;
• ring-shaped granuloma;
• ichthyosis;
• leprosy;
• red flat deprived;
• discoidal red lupus;
• lymphocyte;
• lipoid necrobiasis;
• syphilis;
• B-cell lymphoma (mushroom micaosis).

For primary diagnostics applied. The final diagnosis is set using laboratory studies and biopsies.

Diagnosis of skin sarcoidosis includes two main laboratory tests.

Test KweiMa is the most accurate diagnostic method. It is used quite rarely due to the difficulty of obtaining a reliable source of antigen, as well as the danger of transferring various infections. Test KweiMa implies intradermal administration to the patient of the spleen tissues or the lymph nodes of patient with sarcoidosis. After 4-6 weeks after that, biopsy is taken from the injection zone. If specific granuloma is detected in the tissues, it confirms the diagnosis.

About 70% of patients with sarcoidosis have positive tuberculin samples. This is also taken into account when making a diagnosis.

For diagnosis, the biopsy of lesion focuses is most often used. You should not take samples from the foci of nodular erythema, since it is a non-specific defeat. The material was sent to histological examination. First of all, it is necessary to exclude the infectious cause of the formation of granuloma (tuberculosis), as well as deep micoses and tumors. If a fungal or tuberculous lesion is suspected, a tissue culture can be obtained. This is a long and expensive study, however, it eliminates other similar diseases.

Typical sarcoid lesions are characterized as non-accommodation "naked" granulomas. Around them there are no foci of necrosis, like under tuberculosis. There is only a thin strip of lymphocytic infiltrate. Granulomas are usually limited and consist of epithelial cells, minor necrosis is possible. If there is a scarring, the fibrous fabric extends from the periphery to the lesion center. Granulomas are located in the surface layer of the dermis, but they can penetrate to subcutaneous fiber.

The epithelial cells in granuloma may contain a small number of Langhans giant cells with inclusions of the chumane or ferrous form formation. These findings help histologically differentiate sarcoidosis from other skin diseases.

Methods of treatment

Although skin sarcoidosis is not dangerous for life and leads to physical restrictions only in the small part of patients, his psychological and social consequences are very difficult. Therefore, treatment is shown by the patients who have cosmetic disfiguring damage, ulcers, as well as with progressively deteriorating the flow of the disease.

The choice of therapeutic tactics is complicated by three factors:

• the possibility of spontaneous cure, which occurs in 65% of patients;
• different individual response to therapy;
• serious side effects Drugs used.

Therefore, with a stable course of the disease without cosmetic defects, treatment is not carried out, limited only by observation.

What doctor treats sarcoidosis of the skin?

The patient should refer to the dermatologist. If necessary, consultation of the pulmonic, ophthalmologist, rheumatologist, infectious diseases is appointed.

Are used different methods Treatment - medicines, minimally invasive and surgical techniques.

Medical therapy

Medicase treatment of sarcoidosis of the skin is determined by the severity of the defeat of other organs. In patients with lesions of lungs or hypercalcemia, as well as the pathology of the eyes, nervous system or heart, glucocorticoids are used for intake (prednisone in tablets). In case of acutely arising defeat of many organs, it may be necessary to take immunosuppressants.

If only skin is involved, anti-inflammatory agents (nonsteroid or low doses of prednisolone) are usually prescribed to relieve symptoms.

Glucocorticoids can be administered directly to the plaques themselves. Also used methotrexate and antimalarial means (chlorookhin).

In patients with a persistent course of the disease and a tendency to disfiguring cosmetic defects, biological preparations are proposed, in particular, therapy with an anti-factor necrosis of the alpha tumor.

Preparations that showed their effectiveness in some studies:

• Cyclosporine;
• Isotretinoin;
• Allopurinol;
• Tetracycline and doxycycline;
• Psoralen in combination with ultraviolet irradiation;
• Infliximab, adalimumab and etanecept;
• Leflomide;
• Melatonin;
• Pentoxifillin.

With sarcoidosis, outer therapy is used - various anti-inflammatory creams and ointments containing glucocorticoids. These include: Comfoderm K, hydrocortisone, prednisone, latikort, lockOd, triacort, fluorochort, Afloderm and others.

It must be remembered that the manifestations of sarcoidosis in many cases disappear spontaneously. The choice of medication must entrust the doctor, since all of the listed funds have different activity and side effects.

To accelerate the healing of the elements of the rash and the prevention of the formation of scars, regenerating agents are prescribed. With sarcoidosis of the skin, the stellain ointment contributes to healing and prevents secondary infection of the elements of the rash.

Other methods

How to treat skin sarcoidosis during insufficient effectiveness drugs? For this, surgical methods are applied. With small or significantly disfiguring lesions, you can try to remove them with a scalpel or laser radiation. However, there is a risk of scarring and recurrence of pathology.

Treatment of skin sarcoidosis by folk remedies is ineffective. It can only be used in addition to medicinal therapy. Here are some recipes folk Medicine:

• chopped onion compresses in a mixture with vegetable oil;
• baths with infusion of a series, sage, chamomile;
• ingestion of the tincture of propolis, radiols of pink and other immunostimulating agents.

Observation

Patients with light skin lesions are examined twice a year during the first 2 years, when involving the lungs, the frequency of visits to the doctor increases. All patients are on a dermatologist at least 3 years after the completion of treatment.

When visiting the doctor, X-ray lights are performed, the function of external respiration is estimated and an ECG is carried out. Additionally, blood test may be assigned to the calcium content and vitamin D.

If the patient receives the plaque, it needs a regular inspection from an ophthalmologist.

In patients with skin sarcoidosis, there is an increased risk, non-Khodgkin lymphoma and leukemia, so regular control of blood tests and skin changes are necessary.

Sarcoidosis of the skin implies the formation in different organs or tissues granulul. Thus are called the formation of a rounded form, the composition of which includes different varieties of cells (single Pyrogov-Lanhhans, epithelial). These nodules may have different size and color. There can be a little (up to a dozen) or a lot (hundreds and thousands). They appear in different areas, striking limbs, body, face.

Characteristic features of the disease

Sarcoidosis of the skin (or Disease of Beck-Beka Shaumun) is characterized by the following properties:

• Multisystem;
• The presence of inflammation;
• Benign.

All organs and systems of the body are subject to risk of defeat. Observed both their gradual defeat and parallel.

Attention!Risk group - women of young age. However, men are no exception. Especially common disease in rural areas is especially common.

In addition, it is considered the second prevalence of the systemic disease, represents groups of diseases - granulomotions.

The origin of the aless

The reasons for the appearance and development of the disease to date are definitely not defined. Although previously representatives of medicine adhered to a specific view, relating sarcoidosis to the forms of manifestation of tuberculosis. But the development of science determined the erroneousness of these arguments, denoting the independence of both diseases. However, the possibility of joining one to another is quite likely. Some symptoms are similar, therefore, when diagnosing one, research is carried out, capable of identifying or eliminating the possibility of having another.

Among possible causesserving the impetus to the occurrence of granuloma, allocate:

In its nature, sarcoidosis is non-infectious. Today, most doctors are inclined to believe that it arises as a consequence of an atypical immune response. However, which causes such a reaction, not established. It can be a chemical, and a virus, and something else.

Interesting!Often there are cases of diagnosing sarcoidosis in twins. The reason is obvious - heredity. The composition of the blood changes: the amount of T-lymphocytes with suppressors is reduced, increases - in lymphocytes.

Sarcoidosis of the skin of the face, in the hands it is found as often as the defeat of the lungs or the lymphatic system. The group of organs that are rarely amazed should include the following:

• Vision organs;
• Spleen;
• Liver;
• Bones and others.

Disease varieties

As mentioned earlier, sarcoidosis suggests the presence of granuloma, sarcoidents - rounded formations in which inflammatory processes occur. The nodules are different types:

• Small;
• Large;
• Others.

The first group is a nodules that have the following signs:

The second group has such characteristic features as:

The third group is represented by a combination of different nodules:

Manifestations of disease

Sarcoidosis disease symptoms are as follows:

• Nodules of reddish color;
• Increasing body temperature;
• Painness in the joints.

A long flow is associated with the appearance of plaques, first flat, and then towering. It is also possible to form subcutaneous nodes.

In advanced cases, ulcer develops, amazed nail plates, Changes are not excluded like manifestations of psoriasis.

As a result, the skin is disfigured, aesthetic appeal is lost.

If the sarcoidosis of skin skin and symptoms indicate possible damage to not only skin cover, but also internal organs. In some situations, the disease is deployed only in one place, in other cases (especially with a reduced immunite and the general weakness of the body) there is a defeat of several organs.

Often, the tubercles occur on the limbs (both the lower and the upper, especially in the places of folds), face, torso. At the same time, at first they have a pinkish shade, then acquire the blue and in some cases brownish color. Over time, the fusion of individual elements occurs, respectively, the lesion area increases.

The deformation of the skin, damage its appearance lead not only to the deterioration of physical health, but also inhibition of mental. Often, depressive states are often observed. The patient falls in them due to the dignity on this problem. As a result - nervous disorder.

Interesting!Nervous disorder due to the development of depression contributes to the emergence of new lesions. It turns out vicious circle: Appearance of nodules - Depression - deterioration of the state - the emergence of new formations - even greater oppression of the psyche, etc.

Diagnosing disease

In case of sarcoidosis of the skin of the skin of the skin, they do not always make it possible to diagnose it. A radiograph is used. The presence of shading testifies to the presence of such alend.

In some cases, biopsy helps. A piece of skin is examined under a microscope. Thanks to this procedure, inflammatory processes are revealed and the presence of granuloma.

Interesting!The study of tissue gives the exact result in most cases - 87 out of 100. However, this method, despite high efficiency, not always applied.

In addition, the tuberculin test is put. This method eliminates the presence of tuberculosis, the symptoms of which are similar to sarcoidosis. Not in vain, not so long ago, in the past century, the disease considered by us was ranked to one of the forms of tuberculosis. But later, the doctors took another position: these diseases are independent, although the presence of one does not exclude the presence of another.

The blood is also investigated. Reveal an angiotensin glossy enzyme. Its enlarged number indicates the disease.

Treatment of the disease

During skin sarcoidosis, treatment can be medicamenty, in some situations it is allowed to use folk methods.

In the treatment of drugs, hormone therapy is carried out (mainly local ointment), drugs that stop currenting inflammatory processes (and, as mentioned earlier, the disease is inflammatory). An integrated approach is used. Glucocorticoids are prescribed. The doctor may write preparations against malaria. Often the recipes include methotrexate. If a depressive state is observed, sedatives are discharged. Although the patient is not always depressed, many successfully cope with the nervous disorder without the use of appropriate drugs.

Thus, treatment of the disease is carried out by applying local means, pills inside, as well as antidepressants.

In particularly launched cases, when symptoms of the disease progress, inpatient treatment is produced. Term takes from 1 to 2 months. Next follows outpatient therapy. It can take place for several months.

Granulose resorption is one of the objectives of using methods of traditional medicine. An efficient means is the tincture of propolis. Purchase it in the pharmacy point or prepare yourself (100 g of propolis insisters a mixed with 1 bottle of vodka for 1 month). The course of treatment is stretched for 28 days. Reception is carried out inside. About 30 drops are divorced in water or milk, on an empty stomach.

The use of herbs is another treatment characteristic of traditional medicine. In case of sarcoidosis of the skin in the hands of photos indicate efficiency this method. Tincture radiol pink - best tool In the fight against nodules. Application - coursework. You need 2 courses for 25 days. Break between each - 14 days. 15 drops are enough to take up to 1 and 2 meals. The tincture is divorced in water.

The grape cuttings are used. A decoction is preparing: 1.5 liters of water takes 300 g of plants. Boiled 15-20 minutes. After that cool. It is necessary to strain the decoction. It is mixed with honey and drink 100-200 ml daily, like tea.

Soothing action is observed when using eucalyptus tea. 50 g leaves brew in 0.5 l hot water. Let break throughout the day. In the evening, drink 100 ml in the afternoon with honey.

Each of the beads can be used not only inside, but also locally: process them affected parts of the body.

As one more method of local exposure, an onion-based ointment is used. Korneflood rubs, diluted with sunflower oil. After that applied to the skin.

Sarcoidosis of the skin photo allows you to determine the degree of neglence of the disease. At the initial stage, you can relieve your condition and provoke a speedy recovery, on chronic stage - Warn recurrence.

• Compliance with the basic principles of the head;
• Rejection of bad habits;
• Improving immunity by treating diseases, depressing it;
• Constructing a rational and balanced diet;
• Compliance with a certain diet.

Symptoms can take away, loosen if you follow the following rules when drawing up a daily menu:

• Crushing meals;
• Reduction of the size of one portion;
• Reducing the use of sweet products, salt;
• Elimination of dairy products;
• Increase in the number of fresh vegetables, fruits, especially rich in vitamin C.

• Change of place of residence per area with the best ecology;
• The elimination of interaction with aggressive, including chemicals.

Therapy during pregnancy

Sarcoidosis of the skin can develop during pregnancy. This is due to the fact that the hormonal system is susceptible to restructuring. Although in some cases there is a weakening of the course of the disease or remission - the photo is confirmed.

The development of the disease does not imply an interruption of pregnancy, if we are talking about the appearance of defects on the skin

If a woman has a disease has been diagnosed before the fetal tool period, careful diagnosis is required:

• Radiography;
• Blood study;
• Analysis of urine;
• Assessment of the condition of the respiratory function, etc.

Such studies make it possible to eliminate the presence of sarcoidosis of internal organs, which may affect the normal development of the fetus.

Forecasting

Sarcoidosis disease can be passed independently? Definitely yes. Disappearing symptoms and a decrease in the number of nodules in the photo indicate that. In some cases, even special treatment not required.

Interesting!In addition to the fact that symptoms can pass, they may not appear even when diagnosing the disease.

The chief doctor who is engaged in the problem is a dermatologist. Timely appeal will allow to identify diseases on early stages. Diagnostation occurs as follows: symptoms from the clinical and histological side are estimated. Biopsy is produced. In the conditions of the laboratory, other indicators are investigated, for example, the acceleration of ESP.

Specialist, taking into account the symptoms, competently will diagnose. The fact is that the lack of research results does not exclude the possibility of diagnosing the other similar to sarcoidosis, diseases:

• Systemic red lupus, etc.

Worsening state

Can and be able to identify alert in the early stages - one thing. It is also important to correctly choose the methods of treatment suitable for a specific patient.

Under the late early, sarcoidosis therapy takes a hard form. There are irreparable changes in lymph nodes. It does not exclude the spread of complications for such an organ as a kidney, on a cardiovascular system. Negative consequences are manifested in such cases in the form of urolithiasis, arrhythmia.

Prevention measures

A photograph of sarcoidosis patient after treatment allows us to conclude about the possibility of full cure. However, after it, it is necessary to comply with some rules to prevent the reassessment of such processes.

It is important not to lean on products containing a large amount of calcium. For the disease, the content of this substance increases so much. And the additional burden on the body often leads to the formation of sand, stones in such organs as bladderkidney.

It is important to adhere to a healthy lifestyle, if possible, to exclude a long and purposeful stay in the sun, including in the solarium.

Sarcoidosis (synonyms: Banie-Beck-Shauman disease, benign sarcoidosis, Beki disease) - a systemic disease of unknown etiology, affecting the most different organs and tissues, the pathological basis of which is the epitheliodic cell granuloma without signs of caseous necrosis.

Sarcoidosis disease was first described by the Norwegian dermatologist Beck (1899).

What causes sarcoidosis?

Causes and pathogenesis of sarcoidosis are not clarified. For several decades, the theory of tuberculous origin of sarcoidosis was dominated, i.e., sarcoidosis was considered a special form of tuberculosis infection. In the development of the disease, the role of genetic factors is important, which indicates the large concordance of monosigital twins in this disease compared with the dialicotional, unequal in populations association of sarcoidosis with some tissue compatibility antigen (for example, HLA-B8, DR3), racial differences in morbidity.

The presence of family cases, the defeat of mono- and heterozygous twins confirms the genetic predisposition to granulomatous inflammation. Some authors believe that the imbalance in the system of immunity plays an important role in the development of sarcoidosis.

Summing up all the views on etiology and sarcoidosis pathogenesis, one can conclude that it is polyethological syndrome.

Histopathology Sarcoidosis

With all the forms of sarcoidosis, the same type of changes are noted. In medium and deep departments of the dermis, granuloma, consisting of epithelioid histiocytes with an admixture of lymphocytes, single giant cells like Langhanx or foreign bodies. In contrast to tuberculosis, the curls of curious necrosis, as a rule, is absent. In the resolution stage, there is a substitution of granulomatous islets with a connective tissue.

Patomorphology of sarcoidosis

Typically, the presence of numerous similarly constructed sharply limited granulomes consisting mainly of histiocytic elements. Necrosis is not characteristic. In the center of individual granulul you can see giant cells of the type Pirogov-Langhance, there are also cells of foreign bodies. In the cytoplasm of these cells, the crystalloid inclusions and asteroids of Shaumuna, which, however, are not specific to sarcoidosis, are often discovered. Peripheral bezel from lymphoid elements in this stage is small or completely absent. It is characteristic of these granuloma, the presence of concentrically located collagen fibers around them, staining picropuxin in red and giving a weak chic-positive reaction. Imprigination of silver nitrate according to the fugus method recticulin fibers both around the granuloma and inside it. In the stage of fibrous changes, the granuloma cells are mixed with fibroblastic elements, the reticulin fibers are converted into collagen.

With Beka-Shaumanne sarcoid, epitedoidal islands are localized in the upper third of the dermis, closer to the epidermis, with sarcoid Darius-Russi - mainly in the subcutaneous fat layer. The chubble lupus differs from the sarcoide of Becka-Shaumann only by the presence of sharply extended capillaries at the top of the dermis. In erythrodermic form, the infiltrate consists of small foci of epithelioid cells and a certain number of histiocytes and lymphocytes located around the surface capillaries.

Sarcoidosis needs to be differentiated from tuberculous lupus, at which the tuberculos of the epithelioid structure is also observed, if there is a case of a casoma and a significant number of lymphoid elements in the granuloma of the sarcoidosis from tuberculosis, it is very difficult to distinguish. However, with tuberculosis, granulomatoic infiltrate closely adjacent to the epidermis, often destroying it that the time as in sarcoidosis, infiltrate is separated from the epidermis strip of unchanged collagen. In sarcoidosis in granulomas, as a rule, very few lymphoid cells, there is no or very poorly expressed necrosis, the epidermis of normal thickness or atrophic. At the tuberculosis lupus, the acanthosis is often noted, sometimes ulceration with pseudo-epithelisomatious hyperplasia. Bacteriological research is important. It is difficult to differentiate sarcoidosis from the tuberculoid type of layer, since the leprosy mycobacteria is detected only in 7% of the case. However, granulomas during leprees are located mainly around and in the course of skin nerves. As a result, they have the wrong form, necrosis is often visible in their center.

Histogenesis is not found out. Currently, sarcoidosis is considered as a polyethological disease, mainly an immunopathological genesis. There is a decrease in the number of T-lymphocytes, the imbalance of their main populations; reduced T-cell response to mitogens; weakened reactions of slow-type hypersensitivity; an increase in the amount and hyperactivation of in-lymphocytes with non-specific polyclonal hypergammaglobulinemia, increased level circulating antibodies, especially with noded erythema. In the formation of the granuloma in them, T-helpers are dominated with a relative increase in the number of circulating T-suppressors.

In the development of sarcoid granuloma, K.A. Makarova and N.A. Shapiro (1973) is distinguished by three stages: hyperplastic, granulomatous and stage of fibrous-hyalinical changes. In the hyperplastic stage, there is a proliferation of the cells of the mononuclear-macrofagal system, among which the epithelioid elements appear. Forming granulomas, as a rule, are still unclear disgusting. Multi-core cells in this stage of the process are usually absent. It is believed that the hyperplastic and granulomatous stage are an expression of the increase in the tension of cellular immunity, and fibrous-hyalinical changes - a morphological sign of the onset of the phase of immunological exhaustion. With an electron microscopic study, it is shown that round cells located on the periphery granulomas, considered to be lymphocytes, have lysosomes in which the acid phosphultase and other lysosomal enzymes are. They are monocytes of blood, from which epithelioid cells are formed. There is no evidence of the presence of bacterial fragments in epithelioid cells, although they contain electron-dense and electron-light lysosomes, several autophagic vacuoles and a complex of residual bodies. Giant cells are formed from epithelioid, Shaumanne calves are formed from leases residual gels. Asteroidal tales consist of collagen bumps that have a typical (from 64 to 70 them) frequency. This is due to the fact that the collagen is between epithelioid cells at the time of the formation of the giant KTTOK. In case of immunomorphological examination, in some cases, IgM deposition is shown in the dermo-epidermal boundary area and in the walls of the vessels, as well as IgG in the granulomas themselves and in the surrounding derm.

Symptoms of sarcoidosis

Leather lesion is observed in less than 50% of patients, it can be a polymorphic (such as noded erythema, fifthly erythematous foci), but more often there are various sizes of tuberculous elements, the originality of which is based on the basis of such clinical optionsLike skin sarcoid beck, Angolaupid of Brock-Clery, Zhenne-Tennesone Lupus, subcutaneous sarcoids Darius-Russi. The Sarcoid Beca can manifest itself in the form of small-buggy, including lichenoid, large and diffuse-membrane rashes. In rare cases, the process can occupy all the skin (erythrodermic shape of sarcoidosis). The color of the tubercles is characteristic: a shiny, yellowish-brown, yellowish brown spots appear when diaconia. With a laspiered lupus of the Benene-Tennesone change, the changes are observed mainly on the skin of the nose and the sections of the cheeks in the form of diffuse-gloomy foci of blue-red color; With subcutaneous sarcide, the Dari Ruiet detects hypodermal nodes, the skin over which it becomes pinkish-shinny. There are rare (atypical) versions of sarcoidosis: erythematous (spotted), erythrodermic, lychhenoid (clinically similar to red flat), cruirgoid, dump truck-papillomatous, ring-shaped, figure (zircycinal), erosive-ulcery. ulcerative-gangrenous, papuelcritic, sclerodermoid, post-traveled (scar), elephantatic, clinically similar to a tuberculoid form of leprosy, lupoid necrobiasis, erythematous-squamous (ichthyosis and psoriazo-like), atrophic, angioatous, etc., which can resemble a wide variety of dermatoses, in including such peculiar clinical manifestationslike eczema.

Sarcoidosis is more common in women and is manifested by a large clinical polymorphism. Skin rashes can be nonspecific or specific. The latter are found in histological examination of affected skin.

Depending on the dermatosis manifestation, typical (small-mesel, large-melline, diffuse-infilitative, nodular sarcoid, laspiece of the bency-treesse) and atypical forms of sarcoidosis are distinguished.

The fine-mesel shape is most often characterized by the rash of numerous pink-red spots, which over time are converted into the nodules of the density consistency of the brown-blue color, sizes from the pinhead to the pea, semi-shaped shape, with clear boundaries and a smooth surface, towering over the surrounding skin. Elements are often localized on the face and upper limbs. When diascopia, the smallest yellowish-browned spots ("dust", or dusting phenomenon) are revealed. In the regression at the site of the nodules, hyperpigmentation or surface atrophy, telegangectasia remain.

The large sarcoidosis form is manifested by single or multiple, sharply delimited and distinctly speakers over the level of surrounding skin with semi-shaped flat nodes of purple-brown or blue-drowned color, measuring from 10- to 20-penny coins and more. Elements have a dense consistency, a smooth surface, sometimes covered with teleangectasis, large nodes can ulcerate. Diacopy has a dusting phenomenon.

The diffuse-infiltrative sarcoid is often localized on the face, rarely - on the neck, the hairpiece of the head and manifests itself by the development of plaques of dense consistency of brownish or brownish-blue, with a smooth surface, blurred and slightly protruding over the skin level. The surface can be covered with a network of capillaries. When diascopia, yellowish brown color (symptom of "dust") is found.

Angolaupoid of Brock Fight is usually developing on the nose, cheeks and, extremely rare, in other parts of the body. At the beginning of the disease, round painless spots appear with beans or coins, medium, red or purple red. Gradually, they are transformed into slightly protruding plaques of a rounded shape with clear boundaries, acquiring a brown or rusty shade, with a smooth surface. Rarely palpatorially, you can feel a slight seal of stains, and when diascopia see the drowned points (symptom of "apple jelly"). Sometimes telengetasia visible on the surface of the elements. Plaques are saved for a long time.

Language Lupus of Beanie Tennes. On the skin of the cheek, nose, chin, the rear surface of the fingers and forehead arise small erythema-tous infiltrated foci of lesion. As a result of growth and merging elements, purple-red nodes or plaques, having quite clear boundaries, are formed. There are extended holes of the sebaceous glands and hair follicles. The deterioration of the process is celebrated during the cold season. In some patients, there are damage to lungs, bones, joints, an increase in lymph nodes. Diaconia revealed yellowish points-specks.

A nodular sarcoid (subcutaneous sarcoed of a deer-Russi) is clinically characterized by the formation on the skin of the body, the hips and the bottom of the belly of the subcutaneous nodes in size from 1 to 3 cm in diameter. They are usually few, painless, moving during palpation and for the fusion form glow infiltrates of large sizes, resembling the crust of orange. The skin above the nodes has a normal or slightly blue color, covering foci, - dim pink.

Atypical forms of sarcoidosis. In clinical practice there are several atypical forms: ulcerative, podhid-papular, psoriaziforous, ichthyosis, scleroderm-like, skil-dermic, pailavatous, angiomatous, similar to basaloma, red lupus, etc.

Sarcoidosis patients have the defeat of various organs and systems. In connection with this patient, it is recommended to make radiography and tomography of the chest organs, bones and to conduct an ophthalmic survey.