Which first-line treatment for cutaneous sarcoidosis? A retrospective study of 120 patients
Elisabeth Cohen, C. Lheure, S. Oro, Claire Hotz, Thomas Bettuzzi, François Chasset, V. Descamps, Lydia Deschamps, Matthieu Mahévas, Benjamin Terrier, Pierre Sohier, Sarah Guégan, N. Kramkimel, Delphine Darbord, J. Chanal, Bénédicte Oulès, S. Aractingi, V. Seta, N. Dupin
Abstract
Sarcoidosis is a systemic disease that affects the skin in about 25% of patients. The treatment of cutaneous sarcoidosis is guided by the extent of lesions, associated symptoms and organ involvement. To evaluate rates of response to various potential first-line treatments for cutaneous sarcoidosis during the year following treatment initiation. This retrospective multicentre study included 120 patients with cutaneous sarcoidosis. Treatment response was assessed retrospectively from the patients' medical records. Univariate logistic regression analysis, with an estimation of unadjusted odds ratios (OR) and their 95% CI ,was performed to identify factors associated with complete cutaneous remission (CR), followed by multivariate logistic regression analysis. At one year, 43 of the 120 (36%) included patients had CR. The best response rates were obtained with oral corticosteroids (12/21, 57%), followed by a combination of hydroxychloroquine and topical steroids (6/13, 46%). In multivariate analysis, lupus pernio was the only predictor of a poor cutaneous response. We suggest the use of a combination of hydroxychloroquine and topical steroids as an optimal first-line treatment for cutaneous sarcoidosis, given the known adverse effects of systemic corticosteroids.