Sarcoidosis of the skin: understanding the plaque form

A plaque is a wider area of altered skin that may be slightly raised, firm, smooth, or uneven in colour. In cutaneous sarcoidosis, plaques can be red-brown, purple, or close to the surrounding skin tone. They may occur on the face, around the eyes, on the scalp, or on the trunk and limbs. Some are quiet, while others itch, feel tender, or slowly expand.

The plaque pattern is suggestive rather than diagnostic. Psoriasis, eczema, contact reactions, fungal infection, and other inflammatory conditions can also create patches or plaques. A dermatologist may examine the border and surface, review medicines and symptoms, and recommend a biopsy if the cause is not clear.

Arrange a review for a plaque that persists, enlarges, changes colour, or returns in the same area. Bring photographs that show its progression and a list of products and medicines used on the skin. Use mild cleansing, moisturiser, and sun protection; avoid harsh scrubs and unprescribed strong creams, particularly on the face.

After diagnosis, treatment is guided by the plaque's location, symptoms, extent, and any disease outside the skin. A local steroid injection may be discussed for selected plaques. Oral corticosteroid treatment may be considered when disease requires treatment beyond an individual lesion, with monitoring arranged by the prescribing clinician.

Seek prompt attention if a plaque becomes painful, warm, ulcerated, crusted, or starts bleeding, or if redness spreads quickly. Get urgent help for eye pain, vision changes, breathing difficulty, or chest pain. Even without these warning signs, a changing plaque deserves assessment so that infection, inflammation, and other causes are considered.

Does the texture and distribution fit plaque-form skin sarcoidosis? Is a biopsy advisable? Could a medicine, infection, or another inflammatory condition explain it? Would local treatment be suitable, and what symptoms outside the skin should I report?