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Therapeutic Approach

In the authors’ experience, cutaneous sarcoidosis is difficult to control with topical therapies, though a topical calcineurin inhibitor plus intermittent use of a topical corticosteroid can be trialed. Intralesional corticosteroids may be effective for localized disease, but may be limited by local adverse effects. For moderate to severe disease, systemic therapies are typically necessary with methotrexate and/or TNF-α inhibitors being our preferred first-line agents. In our experience, responses to hydroxycholorquine and minocycline are often inadequate. Thalidomide may be an option in some patients. Prednisone is typically avoided for treatment of skin involvement. JAK inhibition is an investigational approach showing promise in recalcitrant cases. See Table 16-1.

Table 16-1Sarcoidosis Treatment Table

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