Introduction

Sarcoidosis is a systemic disease characterized by non-caseating granulomas with an unknown etiology. It primarily involves the pulmonary and lymphatic systems, but it can also involve organs such as the skin, eyes, spleen, bones, joints, and parotid glands. Skin involvement is seen in approximately one-third of patients [1]. Ganoderma lucidum has been used in traditional Chinese and Japanese medicine as a herbal remedy for over 2000 years due to its immunogenic effects [12]. Modern studies have also reported on the anti-allergic, anti-androgenic, anti-hyperglycemic, anti-oxidant, anti-tumor, anti-viral, and anti-inflammatory properties of G. lucidum [2–5].

The authors could find no data regarding the use of G. lucidum for the treatment of any skin diseases in the literature. Here, we report the case of a 44-year-old male patient with annular cutaneous sarcoidosis of the scalp treated with a soap containing G. lucidum for 3 days who showed almost complete regression of the lesions.

Case Report

Informed consent was obtained from the patient for being included in this case report and for publication of the accompanying images.

A 44-year-old male patient presented to our outpatient clinic for multiple infiltrated plaques on his scalp for 4 years. A dermatological examination showed multiple plaque lesions of annular erythema with central atrophy and raised borders (Fig. 1). An inflammatory and granulomatous reaction in the dermis of the skin, originating beneath the surface epithelium (Fig. 2a), and granulomas consisting of epithelioid histiocytes and multinucleated giant cells (Fig. 2b) were detected during the histopathological assessment of the diagnostic biopsy specimen. A systemic screening was performed when available evidence supported a diagnosis of cutaneous sarcoidosis. The chest X-ray showed bilateral hilar enlargement, and the computed thoracic tomography revealed many lymph nodes in the perivascular region, paratracheal region, subcarinal region, and in both hilar regions, where the short axis of the largest lymph node in the right hilus reached up to 1.4 cm in diameter. The patient was diagnosed with cutaneous sarcoidosis based on the typical lung involvement, elevated angiotensin-converting enzyme levels, and histopathologic findings.

Fig. 1
figure 1

Multiple plaque lesions of annular erythema with central atrophy and raised borders on the scalp

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Fig. 2
figure 2

a Histopathological assessment revealed an inflammatory and granulomatous reaction in the dermis of the skin, originating beneath the surface epithelium (HE ×100). b Granulomas consisting of epithelioid histiocytes and multinucleated giant cells were detected (HE ×400)

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After designing a treatment plan during a control visit, the patient reported that they had found and used a solid soap which contained G. lucidum and goat’s milk from a herbal shop (GanoSoap®, Gano Exel Industries Sdn. Bhd., Malaysia). The patient indicated that they kept the soap foam on the lesion for 1 h, and then rinsed it and repeated the procedure for a total of 3 days. A dermatological examination showed that almost all of the lesions had disappeared (Fig. 3). After 6 months, the lesions recurred and the patient applied the same soap again. The lesions disappeared within a week and the scalp lesions are in remission.

Fig. 3
figure 3

The lesions almost disappeared after using topical Ganoderma lucidum

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Discussion

The cutaneous involvement in sarcoidosis is classified as specific and non-specific skin lesions. The most common specific skin lesions include infiltrated plaques, maculopapular eruptions, infiltration of old scars, lupus pernio, and subcutaneous sarcoidosis. The non-specific skin lesions are often erythema nodosum, erythema multiforme, calcification, and prurigo. In histopathological analyses, specific lesions are characterized by typical granulomas while non-specific lesions show a non-diagnostic inflammatory reaction. Sarcoidosis should not be overlooked by dermatology polyclinics since cutaneous involvement can manifest as a first sign of the disease in some cases. Our patient initially presented with skin lesions, and lung involvement was detected following a thorough examination [6, 7].

Reishi or lingzhi mushroom (G. lucidum) is a species of the Polyporaceae family of fungi which has been used as a remedy in traditional Chinese, Japanese, and Korean medicine in extract fluid. Reishi mushroom is not edible. It usually grows on the stumps of oak and plum trees over a period of approximately 9 months. Several classes of bioactive substances, such as triterpenoids, polysaccharides, nucleosides, sterols, and alkaloids, have been isolated from G. lucidum [8]. Both in vitro and in vivo studies with G. lucidum have demonstrated that G. lucidum polysaccharides have anti-tumor activity through their immunomodulatory, anti-angiogenic, and cytotoxic effects. However, there are many questions that need to be answered before it is accepted and used as an anti-tumor agent [9–11].

Conclusions

Ganoderma lucidum has not been used so far in dermatological diseases. Regression of skin lesions in our patient as early as 3 days supports the anti-inflammatory property of G. lucidum. G. lucidum may be a potential treatment option for the management of skin diseases with cutaneous sarcoidosis and inflammation in the future.