**2. Comprehensive classification of granulomatous disorders**

A comprehensive classification of granulomatous disorders of the skin (according to American Academy of Dermatology, 76th Annual Meeting San Diego, CA USA) (**Table 1**) [4].


#### **Table 1.**

*Classification of granulomatous disorders of skin (American Academy of Dermatology, 76th Annual Meeting San Diego, CA USA).*

### **3. Noninfectious granulomatous disorders**

#### **3.1 Epithelioid granulomas**

#### *3.1.1 Sarcoidosis*

Sarcoidosis is a multiorgan disease. The most commonly affected organs are skin, lungs, and lymph nodes. Different epidemiological factors such as age, sex and race, the duration of the disease, and the sites of involvement affect the presentation of sarcoid. Cutaneous manifestations are extremely variable. Lesions of sarcoidosis are classified as "specific" (noncaseating granulomas are present in biopsy specimens of tissue) or "nonspecific" (lesions develop as a result of a reactive process without the formation of granulomas) [5].

Specific lesions develop in 9–15% of all sarcoidosis patients [5]. These lesions are highly variable in presentations and may be confused with many other skin diseases. The most frequent specific lesions are papules, plaques, lupus pernio, scar sarcoidosis, and subcutaneous sarcoidosis [5]. Erythema nodosum is the most common nonspecific lesion which develops in up to 25% of sarcoidosis cases [6]. Women are more commonly affected than men (W/M, 2:1) and black people than other ethnic groups [7].

**69**

**Figure 1.** *Papular sarcoid.*

*Clinical Manifestations of Sarcoidosis and Granulomatous Disorders*

The clinical appearance is due to the presence of epithelioid cell granulomas in the dermis. The epidermis rarely appears to be clinically involved [8]. Specific lesions are red-brown or red-violaceous in color and generally multiple and do not cause any symptoms which on diascopy reveals the brown-yellow or apple-jelly color, characteristics of granulomatous diseases. But it is usually more opaque than in lupus vulgaris [9]. Different types of cutaneous lesions may coexist in one

Lesions of maculopapular sarcoidosis are usually red-brown to purple in color and less than 1 cm in diameter. Sometimes they may be skin-colored, yellow-brown, or hypopigmented. They are slightly infiltrated, with little epidermal change. They are located on the face, particularly on the eyelids, around the orbits and the nasolabial folds, and on the scalp, occipital area of the neck, trunk, buttocks, and extremities (**Figure 1**). Lesions are commonly disseminated, and mucous membranes may even be involved [7, 9–11]. Diascopy shows the typical apple-jelly color characteristic of granulomatous skin lesions. These lesions are sometimes transient and appear to herald the onset of the disease [11]. Patients with papular lesions had a mean age of 47 years (9–83 years), and the usual duration of disease to heal is less than 2 years [12]. Acute organ involvement, such as sudden lymphadenopathy, acute arthritis, and acute uveitis abnormal chest radiographs, has been associated with this type of

*DOI: http://dx.doi.org/10.5772/intechopen.92236*

*3.1.1.1 Specific lesions of sarcoid*

*3.1.1.1.1 Maculopapular sarcoidosis*

patient.

#### *Clinical Manifestations of Sarcoidosis and Granulomatous Disorders DOI: http://dx.doi.org/10.5772/intechopen.92236*

The clinical appearance is due to the presence of epithelioid cell granulomas in the dermis. The epidermis rarely appears to be clinically involved [8]. Specific lesions are red-brown or red-violaceous in color and generally multiple and do not cause any symptoms which on diascopy reveals the brown-yellow or apple-jelly color, characteristics of granulomatous diseases. But it is usually more opaque than in lupus vulgaris [9]. Different types of cutaneous lesions may coexist in one patient.
