Treatment of angiolupoid sarcoidosis with tofacitinib ointment 2% and pulsed dye laser therapy

Abstract

JAK: Janus kinase PDL: pulsed dye laser INTRODUCTION Sarcoidosis is an inflammatory disease characterized by the formation of granulomas in affected tissues. Sarcoidosis can occur in nearly any organ; approximately one third of patients have skin involvement, which is occasionally the only site of disease. Cutaneous sarcoidosis commonly affects the face and can lead to significant morbidity. Angiolupoid sarcoidosis is a clinical variant, which favors the central face, especially the nasal bridge, and is characterized by prominent telangiectasia formation overlying inflammatory lesions. The only FDA-approved treatment for sarcoidosis is corticosteroids, which are approved for pulmonary involvement. No approved treatments for cutaneous sarcoidosis exist. For cutaneous sarcoidosis, topical and/or intralesional corticosteroids are often used; however, their utility is limited by local adverse effects, including atrophy and hypopigmentation. Other topical therapies, such as calcineurin inhibitors, are often ineffective. Systemic therapies including hydroxychloroquine, methotrexate, antibiotics, and tumor necrosis factor alfa (TNF-a) inhibitors are not reproducibly effective, and their use may be difficult to justify, when disease is limited. The pathogenesis of sarcoidosis has yet to be fully elucidated, but a chronic T cell response appears to play an important role in driving granuloma formation. We and others have found that, in particular, CD41 T-cellederived interferon gamma (IFN-g) may be a primary driver of disease through macrophage activation. Other cytokines such as