A 26-year-old African American woman presents for help with “pimples” on both sides of the nose. She is ostensibly healthy and takes no medications. She did not have significant acne as an adolescent and does not routinely wear cosmetics. Review of systems was entirely negative.
Key point: In this demographic group, asymptomatic erythematous papules on the nose or around the eyes or mouth should suggest sarcoidosis. A small biopsy demonstrated noncaseating granulomata, consistent this diagnosis. A chest radiograph demonstrated bilateral hilar adenopathy without parenchymal involvement.
Treatment: Because of the limited extent of disease, intralesional injections of dilute (5 mg/mL) triamcinolone acetonide were used to eliminate the skin lesions.
Note: An alternative treatment might be application of an ultrapotent corticosteroid preparation. If those maneuvers failed, an oral antimalarial medication (such as hydroxycholorquine) would be the next intervention.