Misha Rosenbach, MD, on the Clinical and Psychosocial Burden of Cutaneous Sarcoidosis

In a recent interview with Dermatology Times, Misha Rosenbach, MD, professor of dermatology and rheumatology at the Hospital of the University of Pennsylvania, discussed the clinical burden of cutaneous sarcoidosis (CS) and the rationale for investigating brepocitinib as a novel therapeutic option.

Sarcoidosis is a multisystem granulomatous disorder characterized by the formation of noncaseating granulomas—organized immune aggregates that develop when the body attempts to wall off persistent inflammatory stimuli. Although pulmonary involvement occurs in approximately 90% of patients, the skin is the second most commonly affected organ, with cutaneous manifestations present in roughly 30% of cases. In the US, an estimated 150,000 to 200,000 individuals live with sarcoidosis, translating to approximately 40,000 patients with CS. The disease disproportionately affects African American patients and shows a slight female predominance, as Rosenbach noted.

Cutaneous sarcoidosis most frequently involves the face and may also appear in scars or tattoos. Lesions can present as violaceous or erythematous papules, plaques, or nodules and may be scaly, crusted, or disfiguring. While symptoms such as pruritus or tenderness may occur, Rosenbach emphasized that psychosocial burden is often the most profound consequence, particularly given the visibility of facial lesions. Patients frequently report impaired social interactions, workplace challenges, and reduced quality of life due to misconceptions about contagion or hygiene.

Currently, no therapies are FDA-approved specifically for CS, and treatment is largely extrapolated from systemic sarcoidosis management. First-line systemic therapy often includes corticosteroids or methotrexate, typically directed by pulmonary involvement. For skin-limited or refractory disease, dermatologists employ topical or intralesional corticosteroids, antimalarials such as hydroxychloroquine, tetracyclines, systemic immunosuppressants, and, in more severe cases such as lupus pernio, TNF inhibitors. However, responses are variable, and many patients experience incomplete disease control.

Brepocitinib, an investigational dual JAK1/TYK2 inhibitor, targets cytokine signaling pathways implicated in granuloma formation. As a next-generation JAK inhibitor with selective pathway targeting, it may offer a more favorable safety profile compared with earlier agents. Given emerging evidence supporting JAK inhibition in granulomatous dermatoses, brepocitinib represents a mechanistically rational approach to addressing a significant unmet need in CS, where effective, targeted therapies remain limited.

Stay tuned for part 2 of our interview with Rosenbach, where he discusses results from the phase 2 BEACON trial.