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December 2006

Hypopigmented Macules in an Indian Man—Diagnosis

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Arch Dermatol. 2006;142(12):1643-1648. doi:10.1001/archderm.142.12.1644-c

Microscopic examination of the skin biopsy specimen revealed aggregates of noncaseating granulomas in the dermis, consistent with sarcoidosis. No foreign material was identified. A portion of the epidermis overlying and adjacent to the granulomas showed significant vacuolar alteration of the basilar layer, with formation of numerous Civatte bodies, indicating an associated interface dermatitis.

The clinical manifestations of sarcoidosis are numerous and variable. The classic presentation of cutaneous sarcoidsis includes macules and papules that demonstrate an “apple-jelly” color on diascopy. Sarcoidosis appearing in scars and lupus pernio are other common manifestations. Less common morphological forms include annular, nodular, ichthyosiform, psoriasiform, verrucous, hypopigmented, and atrophic. Sarcoidosis may present as erythroderma or alopecia.1

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