Cutaneous sarcoidosis may present with multiple morphologic features, most typically firm yellow, brown, violaceous, red or flesh-colored monomorphic papules or nodules affecting the perioral, periocular, medial and/or lateral face. However, plaques, lupus pernio, subcutaneous infiltrates and infiltrates of scars also have been reported. Sarcoid papules typically measure 1 to 5 mm on the face, neck and periorbital skin. They are initially orange or yellow-brown, then turn brownish-red or violaceous before involuting to form faint macules. Papular lesions also may evolve into plaques, particularly on the extremities, face, scalp, back and buttocks.
Unlike sarcoidosis, granulomatous rosacea lacks plaques, lupus pernio, subcutaneous infiltrates and infiltration of scars. Although patients with granulomatous rosacea may report pain, pruritus or burning, these patients do not experience the ushing and erythema seen in more typical rosacea presentations.
Distinguishing features of steroid dermatitis may include full-facial involvement, versus rosacea’s centrofacial predilection. Regarding acne vulgaris, patients with this condition do not experience telangectasias and flushing, while those with rosacea do not experience comedonal lesions but can have hyperpigmented macules.
Dr. Taylor has been an investigator, speaker and advisory board member for Aclaris (maker ofoxymetazoline) and an advisory board member for Galderma (maker of brimonidine).
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