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Sarcoidosis in long standing facial scars
British
ofPlasticSurger)
Journal
(x978),
SARCOIDOSIS
31,
266-267
IN LONG STANDING
By K. C. CONDON,M.Ch., F.R.C.S.Ed.,
F.R.C.S.I.,
FACIAL
SCARS
Consultant Plastic Surgeon
and
DENISO’SULLIVAN, M.D., F.F.C.P., F.R.C.P.I., F.A.C.P.(Hon.), Professor of Medicine Southern Health Board, St Finbarr’s Hospital, Douglas Road, Cork, Ireland
CASE REPORTS Case I. This zg-year-old man had a vertical scar on his forehead resulting from a laceration I I years earlier. Three months before being referred for plastic surgery, it began to enlarge and was now raised into an oedematous-looking ridge (Fig. I). It was cool, smooth, whitish and neither painful nor tender. It was biopsied and reported as “a chronic granulomatous reaction . . . in keeping with A chest X-ray showed hilar adenopathy and some parenchymal thickening sarcoidosis”. towards the right base but he had no symptoms related to these and his blood chemistry was normal. Three months later under medical care without steroids the radiological picture was much improved. Case 2. This 34-year-old man was referred only I month after Case I and the diagnosis of sarcoid in his upper lip scar (Fig. 2) was confidently made and confirmed histologically. He The scar dated from his childhood and for some years had tended to swell and enlarge. had no other evidence of sarcoidosis.
DISCUSSION Sarcoidosis is known to occur on the face (O’Brien, 1970) where it usually begins in the nose and slowly spreads more or less symmetrically to involve the cheeks and
FIG. I.
Case I. This forehead FIG.
2.
Case
2.
scar had been quiescent for over IO years but had increased size over the previous 3 months.
A 3o-year-old
markedly
linear scar which had become swollen and waxy looking. 266
in
SARCOIDOSIS
IN
LONG
STANDING
FACIAL
SCARS
267
lips. So far as we have been able to find, however, this is the first time it has been reported in facial scars although Sarkar (1967) described its occurrence in part of an appendicectomy scar. Two instances of a rarity being seen within a short interval of each other is a well known medical phenomenon. It should also be noted however that the Irish are particularly prone to sarcoid; James (1976) reported that the incidence among Irishmen and Irishwomen living in London was IO times higher than in the general population_ Both cases were first referred to a plastic surgeon and sarcoid is a diagnosis to be borne in mind when confronted with an unusual scar. If other cutaneous sarcoids are injected with triamcinolone, all the swelling disappears in 3 to 4 days although it gradually recurs over a period of months (Tom Gibson, personal communication). This is much quicker than the effect of triamcinolone on a hypertrophic scar and might be a useful diagnostic aid. REFERENCES D. G. (1976). “A textbook of medicine”, edited by Beeson and McDermotts. W. C. Saunders Co., Philadelphia, p. 166. O’BRIEN, P. (1970). Sarcoidosis of the nose. British Journal of Plastic Surgery, 23, 242. SARKAR, T. K. (1967). Sarcoidosis diagnosed by biopsy of the scar. 3oz~nulof the Indim Medical Association, 48, 29.
JAMES,
ofPlasticSurger)
Journal
(x978),
SARCOIDOSIS
31,
266-267
IN LONG STANDING
By K. C. CONDON,M.Ch., F.R.C.S.Ed.,
F.R.C.S.I.,
FACIAL
SCARS
Consultant Plastic Surgeon
and
DENISO’SULLIVAN, M.D., F.F.C.P., F.R.C.P.I., F.A.C.P.(Hon.), Professor of Medicine Southern Health Board, St Finbarr’s Hospital, Douglas Road, Cork, Ireland
CASE REPORTS Case I. This zg-year-old man had a vertical scar on his forehead resulting from a laceration I I years earlier. Three months before being referred for plastic surgery, it began to enlarge and was now raised into an oedematous-looking ridge (Fig. I). It was cool, smooth, whitish and neither painful nor tender. It was biopsied and reported as “a chronic granulomatous reaction . . . in keeping with A chest X-ray showed hilar adenopathy and some parenchymal thickening sarcoidosis”. towards the right base but he had no symptoms related to these and his blood chemistry was normal. Three months later under medical care without steroids the radiological picture was much improved. Case 2. This 34-year-old man was referred only I month after Case I and the diagnosis of sarcoid in his upper lip scar (Fig. 2) was confidently made and confirmed histologically. He The scar dated from his childhood and for some years had tended to swell and enlarge. had no other evidence of sarcoidosis.
DISCUSSION Sarcoidosis is known to occur on the face (O’Brien, 1970) where it usually begins in the nose and slowly spreads more or less symmetrically to involve the cheeks and
FIG. I.
Case I. This forehead FIG.
2.
Case
2.
scar had been quiescent for over IO years but had increased size over the previous 3 months.
A 3o-year-old
markedly
linear scar which had become swollen and waxy looking. 266
in
SARCOIDOSIS
IN
LONG
STANDING
FACIAL
SCARS
267
lips. So far as we have been able to find, however, this is the first time it has been reported in facial scars although Sarkar (1967) described its occurrence in part of an appendicectomy scar. Two instances of a rarity being seen within a short interval of each other is a well known medical phenomenon. It should also be noted however that the Irish are particularly prone to sarcoid; James (1976) reported that the incidence among Irishmen and Irishwomen living in London was IO times higher than in the general population_ Both cases were first referred to a plastic surgeon and sarcoid is a diagnosis to be borne in mind when confronted with an unusual scar. If other cutaneous sarcoids are injected with triamcinolone, all the swelling disappears in 3 to 4 days although it gradually recurs over a period of months (Tom Gibson, personal communication). This is much quicker than the effect of triamcinolone on a hypertrophic scar and might be a useful diagnostic aid. REFERENCES D. G. (1976). “A textbook of medicine”, edited by Beeson and McDermotts. W. C. Saunders Co., Philadelphia, p. 166. O’BRIEN, P. (1970). Sarcoidosis of the nose. British Journal of Plastic Surgery, 23, 242. SARKAR, T. K. (1967). Sarcoidosis diagnosed by biopsy of the scar. 3oz~nulof the Indim Medical Association, 48, 29.
JAMES,