Annales de médecine interne
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Sarcoidosis is a systemic granulomatous condition of unknown origin. It is defined by histological features of epithelioid and giant-cell granuloma without caseous necrosis. Skin manifestations are observed in 25% of the cases of sarcoidosis, sometimes appearing as the inaugural symptom. ⋯ General corticosteroid therapy remains the mainstay treatment for severe skin disorders in sarcoidosis. APS and local corticoid therapy can be useful when systemic corticosteroids are not needed or to achieve a steroid-sparing effect. Indications for methotrexate and new compounds such as thalidomide or certain antibiotics with an immunomodulator effect remain to be evaluated.
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A neurological localization is observed in 20% of the cases of sarcoidosis. Involvement of the central and/or peripheral nervous system is generally observed in Caucasians while cranial nerve localization predominates in blacks. Beside these particular elements, lymphocytic meningitis, psychiatric disorders, insipid diabetes, and cranial nerve palsy are the most frequent signs. ⋯ Histological proof of sarcoidosis granuloma is required for diagnosis but may be difficult to obtain when neurological signs are not associated with another localization. Systemic treatment is indicated, based on steroids, sometimes associated with another immunosuppressive agent. After acute treatment, chronic therapy must be maintained for years, and sometimes for life.