Cutaneous Sarcoidosis on Black Skin: Epidemiological, Clinical and Therapeutic Aspects in Dermatology, Lomé (Togo)

*Corresponding author: Dr. Bayaki Saka, Department of dermatology and IST, Sylvanus olympio teaching hospital, University of Lomé, B.P: 30785, Lome, Togo, E-mail: barthelemysaka@yahoo.fr Citation: Saka B, Teclessou J, Akakpo AS, Mouhari-Toure A, Adjoh K, et al. (2017) Cutaneous Sarcoidosis on Black Skin: Epidemiological, Clinical and Therapeutic Aspects in Dermatology, Lomé (Togo). Enliven: Clin Dermatol 3(2): 003.


Introduction
Sarcoidosis is a systemic granulomatous disease of unknown etiology with skin manifestations [1,2]. Skin manifestations are classified as specific if the lesions have granulomas histologically and as nonspecific if they are not characterized by granulomatous inflammation (mainly erythema nodosum) [3,4]. In sub-Saharan Africa, many studies have been conducted on cutaneous sarcoidosis particularities in black skin [5][6][7][8][9], but none have been reported in Togo yet. The aim of this study was to report the epidemiology of cutaneous sarcoidosis and describe the clinical, paraclinic and therapeutic aspects of this disease in dermatology units in Togo.

Methods
We retrospectively reviewed the medical records of all patients diagnosed with cutaneous sarcoidosis at the dermatology departments of Sylvanus

Results
During the study period, 18 cases of cutaneous sarcoidosis were recorded.
The mean age of the patients was 58.9 years, ranging from 24 to 69 years.
The sex ratio (F/M) was 0.3. The mean length time before consultation was 26.4 months, range from 2 months to 15 years. The time to consultation was greater than one year in 8 patients. General symptoms such as asthenia (8 cases), weight loss (6 cases), fever (1 case) and arthralgia (one case) were noted in 13 patients, with some patients having several types of general symptoms. The main lesions were represented essentially by papules (16 cases) and scars sarcoidosis (12 cases), and mainly located on the face (13 cases) and the neck (7 cases) ( Table 1). Extra cutaneous lesions were lymph nodes (3 cases), respiratory involvement (2 cases), association of lymph nodes and respiratory involvement (2 cases), joints affections (1 case) and neurological involvement (1 case). Biological abnormalities were anemia (one case), acceleration of sedimentation rate (6 cases), angiotensin converting enzyme growth (one case) and hypergammaglobulinemia (one case). Chest X-ray was abnormal in nine of the 14 patients in whom it was performed. These were isolated mediastinal lymphadenopathy (stage I, 2 cases), isolated parenchymal damage (stage 2, 5 cases) coexistence of mediastinal lymphadenopathy and parenchymal damage (stage 3, 2 cases).
The pulmonary functional test performed in 3 patients with respiratory symptoms showed a restrictive lung syndrome. A tuberculin anergy was found in 2 of the 6 patients in whom tuberculin intradermal test was performed. Patients with isolated cutaneous sarcoidosis were treated with a topical corticosteroid (8 cases) or a hydroxychloroquine (one case). The nine other patients were treated with oral corticosteroids, which were replaced by methotrexate following a corticodependence in two cases. We

Discussion
Our study conducted in dermatology departments in Lomé, during a 17-year period, report 18 cases of cutaneous sarcoidosis. With the 18 cases recorded in 17 years, our study confirms the extreme rarity of cutaneous sarcoidosis in sub-Saharan Africa. An Ivorian study had identified 24 cases of cutaneous sarcoidosis in 25 years [5] and a Senegalese series had recorded 20 cases in 40 years [6]. Also, a Nigerian series had identified 4 cases in 10 years [7]. We believe that this low frequency of cutaneous sarcoidosis in sub-Saharan Africa could be explained by the lack of economic and geographical accessibility to health services. In addition, it appears that sarcoidosis is generally believed to be rarer in African blacks, especially along the West African coast [8].
The female predominance which was observed in our study is classically observed in cutaneous sarcoidosis [2,10,11], although Kaloga et al. [5] noted an equal incidence among the two sexes.

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In our study, half of patients had pulmonary damage on chest X-ray, but only 4 had respiratory symptoms. In Ivory Coast, 13 patients had pulmonary damage on chest X-ray but only 5 had respiratory symptoms [5]. These results emphasize on the necessity of a systematic chest X-ray in case of cutaneous sarcoidosis even in the absence of respiratory symptoms, because the treatment would depend on the other organ involvement and the severity of clinical disease.
Concerning the treatment, on one hand, topical corticosteroids and hydroxychloroquine have been effective in patients with isolated cutaneous disease. On the other hand, oral corticosteroids appear to be ineffective in pulmonary involvement since we have recorded two cases of corticodependence and two cases of recurrence after complete remission.
These results suggest that low-cost treatments such as methotrexate, isotretinoin, allopurinol that have been shown to be effective [12]

Consent for Publication
The Department of Dermatology of CHU Sylvanus Olympio, University of Lomé authorized the publication of this manuscript.

Availability of Data and Materials
The datasets supporting the conclusions of this article are included within the manuscript and its supporting material.