*3.1.1.1.3 Lupus pernio*

It is the characteristic cutaneous manifestation of sarcoidosis [15]. Lupus pernio refers primarily to diffuse, violaceous to telangiectatic plaque lesions of the nose, cheeks, ears, and fingers [16–19] (**Figure 3**). It tends to appear in older people, especially the black women affected more frequently [20, 21]. The lesions enlarge and become confluent to form progressively disfiguring nodular plaques on the nose and adjacent cheeks [21]. The lesions can involve the upper respiratory tract and cause nasal ulceration, obstruction, and perforation of the nasal septum [15, 22, 23]. Some cases have developed plaques on the arms, thighs, and buttocks [21, 24] and sausage-shaped expansion of the phalanges [16, 25]. This form of sarcoidosis can be recalcitrant to systemic corticosteroids and other immune-suppressants and may be an indicator of current or impending organ involvement [24]. Also it usually follows an extremely chronic course—2–25 years in published series [11, 13].
