Oral steroids Benefits

Oral glucocorticoids are postulated to work in systemic sarcoidosis by virtue of their

Figure 49.1 Cutaneous sarcoidosis

anti-inflammatory and immunosuppressant capabilities. For the same reasons, they are often offered as first-line treatment for lesions of cutaneous sarcoidosis.14,15 However, there is very little evidence to support their use for this indication. Several studies have been conducted to evaluate the efficacy of steroids (particularly long-term steroids) for treatment of pulmonary sarcoidosis. Although some study participants were noted to have skin findings, none of these studies evaluated resolution or improvement of skin lesions as a clinical endpoint.16-23 In 1967, James et a/.24 conducted a randomised prospective, placebo-controlled trial in which they compared the efficacy of prednisolone, 20 mg/day, with oxyphenbutazone, 400 mg/day, and placebo for the treatment of sarcoidosis with multisystem involvement. Seventy-five patients were included in the study (27 prednisolone, 24 oxyphenbutazone, 24 placebo), and therapy was administered to all patients for 6 months. Eleven patients in the prednisolone group, seven in the oxyphenbutazone group, and eight in the placebo group had skin manifestations of sarcoidosis at the start of the study. At the end of 6 months, two of 11 patients in the prednisolone group had improvement of their skin lesions compared with one of seven patients in the oxyphenbutazone group. In the placebo group, skin lesions improved in one patient, and deteriorated in two. Several open non-randomised non-controlled trials have been published. Sharma et a/.25 published a summary of the management and clinical course of 41 patients with sarcoidosis treated at the University of Southern California's Sarcoidosis Clinic. Of the six patients with lupus pernio, five received oral corticosteroids, and only one had improvement of her lesions. Of the nine patients with skin plaques, seven received corticosteroids or chloroquine or both; however, only one patient had improvement of his skin lesions. Corticosteroids were either not administered or their effects were not included for the remaining patients. Johns et al26 reported the results of an unpublished retrospective review by Hackett and Hambrick describing treatment of cutaneous sarcoidosis at Johns Hopkins Sarcoid Clinic. Systemic prednisone was used in 32 patients with cutaneous manifestations, and improvement of lesions was noted in 12 patients. Verdegem et al27 reported on four patients with ulcerative sarcoidosis. Case one had partial improvement of her lesions with oral methylprednisone, 48 mg/day; case two had resolution of her lesions with a combination of prednisone, 10 mg/day, and hydroxychloroquine sulphate, 200 mg/day; case three had resolution of her lesions with a combination of prednisone, 30 mg/day, hydroxychloroquine sulphate, 200 mg/day and antibiotics; case 4 had resolution of her lesions with prednisone, 60 mg/day.

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