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American Journal of Clinical Dermatology

, Volume 20, Issue 3, pp 409–422 | Cite as

Biologic Therapy in the Treatment of Cutaneous Sarcoidosis: A Literature Review

  • Christina Dai
  • Shawn Shih
  • Ahmed Ansari
  • Young Kwak
  • Naveed SamiEmail author
Review Article

Abstract

Sarcoidosis is an inflammatory disease defined by the presence of non-caseating granulomas. It can affect a number of organ systems, most commonly the lungs, lymph nodes, and skin. Cutaneous manifestations of sarcoidosis can impose a significant detriment to patients’ quality of life. The accepted first-line therapy for cutaneous sarcoidosis consists of intralesional and oral corticosteroids, but these can fail in the face of resistant disease and corticosteroid-induced adverse effects. Second-line agents include tetracyclines, hydroxychloroquine, and methotrexate. Biologics are an emerging treatment option for the management of cutaneous sarcoidosis, but their role in management is not well-defined. In this article, we reviewed the currently available English-language publications on the use of biologics in managing cutaneous sarcoidosis. Although somewhat limited, the data in published studies support the use of both infliximab and adalimumab as third-line treatments for chronic or resistant cutaneous sarcoidosis. There were also scattered reports of etanercept, rituximab, golimumab, and ustekinumab being utilized as third-line agents with varying degrees of success. Larger and more extensive investigations are required to further assess the adverse effect profile and optimal dosing for managing cutaneous sarcoidosis.

Notes

Compliance with Ethical Standards

Funding

No funding was received for the preparation of this review.

Conflict of interest

Christina Dai, Shawn Shih, Ahmed Ansari, and Young Kwak have no conflicts of interest to declare. Naveed Sami was a previous sub-investigator for Centocor clinical trial for sarcoidosis.

References

  1. 1.
    Haimovic A, Sanchez M, Judson MA, Prystowsky S. Sarcoidosis: a comprehensive review and update for the dermatologist: part I. Cutaneous disease. J Am Acad Dermatol. 2012;66(5):699 e1–18 (quiz 717–8).Google Scholar
  2. 2.
    Petit A, Dadzie OE. Multisystemic diseases and ethnicity: a focus on lupus erythematosus, systemic sclerosis, sarcoidosis and Behcet disease. Br J Dermatol. 2013;169(Suppl 3):1–10.Google Scholar
  3. 3.
    Heath CR, David J, Taylor SC. Sarcoidosis: are there differences in your skin of color patients? J Am Acad Dermatol. 2012;66(1):121 e1–14.Google Scholar
  4. 4.
    Doherty CB, Rosen T. Evidence-based therapy for cutaneous sarcoidosis. Drugs. 2008;68(10):1361–83.Google Scholar
  5. 5.
    Volden G. Successful treatment of chronic skin diseases with clobetasol propionate and a hydrocolloid occlusive dressing. Acta Dermatovenereol. 1992;72(1):69–71.Google Scholar
  6. 6.
    Baughman RP, Lower EE. Evidence-based therapy for cutaneous sarcoidosis. Clin Dermatol. 2007;25(3):334–40.Google Scholar
  7. 7.
    Fetil E, Ozkan S, Ilknur T, Kavukcu S, Kusku E, Lebe B. Sarcoidosis in a preschooler with only skin and joint involvement. Pediatr Dermatol. 2003;20(5):416–8.Google Scholar
  8. 8.
    Pariser RJ, Paul J, Hirano S, Torosky C, Smith M. A double-blind, randomized, placebo-controlled trial of adalimumab in the treatment of cutaneous sarcoidosis. J Am Acad Dermatol. 2013;68(5):765–73.Google Scholar
  9. 9.
    Heidelberger V, Ingen-Housz-Oro S, Marquet A, Mahevas M, Bessis D, Bouillet L, et al. Efficacy and tolerance of anti-tumor necrosis factor alpha agents in cutaneous sarcoidosis: a French Study of 46 cases. JAMA Dermatol. 2017;153(7):681–5.Google Scholar
  10. 10.
    Jamilloux Y, Cohen-Aubart F, Chapelon-Abric C, Maucort-Boulch D, Marquet A, Perard L, et al. Efficacy and safety of tumor necrosis factor antagonists in refractory sarcoidosis: a multicenter study of 132 patients. Semin Arthr Rheum. 2017;47(2):288–94.Google Scholar
  11. 11.
    Judson MA, Baughman RP, Costabel U, Flavin S, Lo KH, Kavuru MS, et al. Efficacy of infliximab in extrapulmonary sarcoidosis: results from a randomised trial. Eur Respir J. 2008;31(6):1189–96.Google Scholar
  12. 12.
    Baughman RP, Drent M, Kavuru M, Judson MA, Costabel U, du Bois R, et al. Infliximab therapy in patients with chronic sarcoidosis and pulmonary involvement. Am J Respir Crit Care Med. 2006;174(7):795–802.Google Scholar
  13. 13.
    Baughman RP, Judson MA, Lower EE, Drent M, Costabel U, Flavin S, et al. Infliximab for chronic cutaneous sarcoidosis: a subset analysis from a double-blind randomized clinical trial. Sarcoidosis Vasc Diffuse Lung Dis. 2016;32(4):289–95.Google Scholar
  14. 14.
    Stagaki E, Mountford WK, Lackland DT, Judson MA. The treatment of lupus pernio: results of 116 treatment courses in 54 patients. Chest. 2009;135(2):468–76.Google Scholar
  15. 15.
    Baughman RP, Lower EE. Infliximab for refractory sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2001;18(1):70–4.Google Scholar
  16. 16.
    Mallbris L, Ljungberg A, Hedblad MA, Larsson P, Stahle-Backdahl M. Progressive cutaneous sarcoidosis responding to anti-tumor necrosis factor-alpha therapy. J Am Acad Dermatol. 2003;48(2):290–3.Google Scholar
  17. 17.
    Crouser ED, Lozanski G, Fox CC, Hauswirth DW, Raveendran R, Julian MW. The CD4+ lymphopenic sarcoidosis phenotype is highly responsive to anti-tumor necrosis factor-{alpha} therapy. Chest. 2010;137(6):1432–5.Google Scholar
  18. 18.
    Saleh S, Ghodsian S, Yakimova V, Henderson J, Sharma OP. Effectiveness of infliximab in treating selected patients with sarcoidosis. Respir Med. 2006;100(11):2053–9.Google Scholar
  19. 19.
    Chung J, Rosenbach M. Extensive cutaneous sarcoidosis and coexistant Crohn disease with dual response to infliximab: case report and review of the literature. Dermatol Online J. 2014;21(3).Google Scholar
  20. 20.
    Tuchinda P, Bremmer M, Gaspari AA. A case series of refractory cutaneous sarcoidosis successfully treated with infliximab. Dermatol Ther. 2012;2(1):11.Google Scholar
  21. 21.
    Sene T, Juillard C, Rybojad M, Cordoliani F, Lebbe C, Morel P, et al. Infliximab as a steroid-sparing agent in refractory cutaneous sarcoidosis: single-center retrospective study of 9 patients. J Am Acad Dermatol. 2012;66(2):328–32.Google Scholar
  22. 22.
    Cerniglia B, Judson MA. Infliximab-induced hypothyroidism: a novel case and postulations concerning the mechanism. Case Rep Med. 2013;2013:216939.Google Scholar
  23. 23.
    Tu J, Chan J. Cutaneous sarcoidosis and infliximab: evidence for efficacy in refractory disease. Australas J Dermatol. 2014;55(4):279–81.Google Scholar
  24. 24.
    Sweiss NJ, Welsch MJ, Curran JJ, Ellman MH. Tumor necrosis factor inhibition as a novel treatment for refractory sarcoidosis. Arthr Rheum. 2005;53(5):788–91.Google Scholar
  25. 25.
    Rosen T, Doherty C. Successful long-term management of refractory cutaneous and upper airway sarcoidosis with periodic infliximab infusion. Dermatol Online J. 2007;13(3):14.Google Scholar
  26. 26.
    Blanco R, Gonzalez-Gay MA, Gonzalez-Lopez MA, Fernandez-Llaca H, Gonzalez-Vela MC. Refractory highly disfiguring lupus pernio: a dramatic and prolonged response to infliximab. Int J Dermatol. 2015;54(8):e321–2.Google Scholar
  27. 27.
    Thielen AM, Barde C, Saurat JH, Laffitte E. Refractory chronic cutaneous sarcoidosis responsive to dose escalation of TNF-alpha antagonists. Dermatology. 2009;219(1):59–62.Google Scholar
  28. 28.
    Wanat KA, Rosenbach M. Case series demonstrating improvement in chronic cutaneous sarcoidosis following treatment with TNF inhibitors. Arch Dermatol. 2012;148(9):1097–100.Google Scholar
  29. 29.
    Panselinas E, Rodgers JK, Judson MA. Clinical outcomes in sarcoidosis after cessation of infliximab treatment. Respirology. 2009;14(4):522–8.Google Scholar
  30. 30.
    Heffernan MP, Anadkat MJ. Recalcitrant cutaneous sarcoidosis responding to infliximab. Arch Dermatol. 2005;141(7):910–1.Google Scholar
  31. 31.
    Haley H, Cantrell W, Smith K. Infliximab therapy for sarcoidosis (lupus pernio). Br J Dermatol. 2004;150(1):146–9.Google Scholar
  32. 32.
    Maneiro JR, Salgado E, Gomez-Reino JJ, Carmona L. Efficacy and safety of TNF antagonists in sarcoidosis: data from the Spanish registry of biologics BIOBADASER and a systematic review. Semin Arthr Rheum. 2012;42(1):89–103.Google Scholar
  33. 33.
    Jounieaux F, Chapelon C, Valeyre D, Israel Biet D, Cottin V, Tazi A, et al. Infliximab treatment for chronic sarcoidosis: a case series (in French). Revue Mal Respir. 2010;27(7):685–92.Google Scholar
  34. 34.
    Yee AM, Pochapin MB. Treatment of complicated sarcoidosis with infliximab anti-tumor necrosis factor-alpha therapy. Ann Intern Med. 2001;135(1):27–31.Google Scholar
  35. 35.
    Heffernan MP, Smith DI. Adalimumab for treatment of cutaneous sarcoidosis. Arch Dermatol. 2006;142(1):17–9.Google Scholar
  36. 36.
    Mirzaei A, Joharimoghadam MM, Zabihiyeganeh M. Adalimumab-responsive refractory sarcoidosis following multiple eyebrow tattoos: a case report. Tanaffos. 2017;16(1):80–3.Google Scholar
  37. 37.
    Kaiser CA, Cozzio A, Hofbauer GF, Kamarashev J, French LE, Navarini AA. Disfiguring annular sarcoidosis improved by adalimumab. Case Rep Dermatol. 2011;3(2):103–6.Google Scholar
  38. 38.
    Philips MA, Lynch J, Azmi FH. Ulcerative cutaneous sarcoidosis responding to adalimumab. J Am Acad Dermatol. 2005;53(5):917.Google Scholar
  39. 39.
    Field S, Regan AO, Sheahan K, Collins P. Recalcitrant cutaneous sarcoidosis responding to adalimumab but not to etanercept. Clin Exp Dermatol. 2010;35(7):795–6.Google Scholar
  40. 40.
    Judson MA. Successful treatment of lupus pernio with adalimumab. Arch Dermatol. 2011;147(11):1332–3.Google Scholar
  41. 41.
    Cohen GF, Wolfe CM. Recalcitrant diffuse cutaneous sarcoidosis with perianal involvement responding to adalimumab. J Drugs Dermatol. 2017;16(12):1305–6.Google Scholar
  42. 42.
    Hagan CE, Offiah M, Brodell RT, Jackson JD. Chronic verrucous sarcoidosis associated with human papillomavirus infection: improvement with adalimumab. JAAD Case Rep. 2018;4(9):866–8.Google Scholar
  43. 43.
    Tuchinda C, Wong HK. Etanercept for chronic progressive cutaneous sarcoidosis. J Drugs Dermatol. 2006;5(6):538–40.Google Scholar
  44. 44.
    Khanna D, Liebling MR, Louie JS. Etanercept ameliorates sarcoidosis arthritis and skin disease. J Rheumatol. 2003;30(8):1864–7.Google Scholar
  45. 45.
    Utz JP, Limper AH, Kalra S, Specks U, Scott JP, Vuk-Pavlovic Z, et al. Etanercept for the treatment of stage II and III progressive pulmonary sarcoidosis. Chest. 2003;124(1):177–85.Google Scholar
  46. 46.
    Papp KA. The safety of etanercept for the treatment of plaque psoriasis. Ther Clin Risk Manag. 2007;3(2):245–58.Google Scholar
  47. 47.
    Judson MA, Baughman RP, Costabel U, Drent M, Gibson KF, Raghu G, et al. Safety and efficacy of ustekinumab or golimumab in patients with chronic sarcoidosis. Eur Respir J. 2014;44(5):1296–307.Google Scholar
  48. 48.
    Bomprezzi R, Pati S, Chansakul C, Vollmer T. A case of neurosarcoidosis successfully treated with rituximab. Neurology. 2010;75(6):568–70.Google Scholar
  49. 49.
    Cinetto F, Compagno N, Scarpa R, Malipiero G, Agostini C. Rituximab in refractory sarcoidosis: a single centre experience. Clin Mol Allergy. 2015;13(1):19.Google Scholar
  50. 50.
    Lamrock E, Brown P. Development of cutaneous sarcoidosis during treatment with tumour necrosis alpha factor antagonists. Australas J Dermatol. 2012;53(4):e87–90.Google Scholar
  51. 51.
    Marcella S, Welsh B, Foley P. Development of sarcoidosis during adalimumab therapy for chronic plaque psoriasis. Australas J Dermatol. 2011;52(3):e8–11.Google Scholar
  52. 52.
    Salvatierra J, Magro-Checa C, Rosales-Alexander JL, Raya-Alvarez E. Acute sarcoidosis as parotid fever in rheumatoid arthritis under anti-tumor necrosis factor-alpha therapy. Rheumatology (Oxford). 2011;50(7):1346–8.Google Scholar
  53. 53.
    Bonafede MM, Gandra SR, Watson C, Princic N, Fox KM. Cost per treated patient for etanercept, adalimumab, and infliximab across adult indications: a claims analysis. Adv Ther. 2012;29(3):234–48.Google Scholar
  54. 54.
    Keijsers RG, Verzijlbergen JF, van Diepen DM, van den Bosch JM, Grutters JC. 18F-FDG PET in sarcoidosis: an observational study in 12 patients treated with infliximab. Sarcoidosis Vasc Diffuse Lung Dis. 2008;25(2):143–9.Google Scholar
  55. 55.
    Sweiss NJ, Barnathan ES, Lo K, Judson MA, Baughman R. C-reactive protein predicts response to infliximab in patients with chronic sarcoidosis. Sarcoidosis Vasc Diffuse Lung Dis. 2010;27(1):49–56.Google Scholar
  56. 56.
    Damsky W, Thakral D, Emeagwali N, Galan A, King B. Tofacitinib treatment and molecular analysis of cutaneous sarcoidosis. N Engl J Med. 2018;379(26):2540–6.Google Scholar
  57. 57.
    Rotenberg C, Besnard V, Brillet PY, Giraudier S, Nunes H, Valeyre D. Dramatic response of refractory sarcoidosis under ruxolitinib in a patient with associated JAK2-mutated polycythemia. Eur Respir J. 2018;52(6).Google Scholar
  58. 58.
    Kono M, Kono M, Jodo S. A case of refractory acute sarcoid myopathy successfully treated with intravenous immunoglobulin. Scand J Rheumatol. 2018;47(2):168–9.Google Scholar
  59. 59.
    Linger MW, van Driel ML, Hollingworth SA. Off-label use of tumour necrosis factor-alpha inhibitors and anakinra at an Australian tertiary hospital. Intern Med J. 2016;46(12):1386–91.Google Scholar
  60. 60.
    Shenoy N, Tesfaye M, Brown J, Simmons N, Weiss D, Meholli M, et al. Corticosteroid-resistant bulbar neurosarcoidosis responsive to intravenous immunoglobulin. Pract Neurol. 2015;15(4):289–92.Google Scholar
  61. 61.
    Awano N, Inomata M, Kondoh K, Satake K, Kamiya H, Moriya A, et al. Mixed-type multicentric Castleman’s disease developing during a 17-year follow-up of sarcoidosis. Intern Med. 2012;51(21):3061–6.Google Scholar
  62. 62.
    Semiz H, Kobak S. Coexistence of sarcoidosis and adult onset Still disease. Reumatol Clin.  https://doi.org/10.1016/j.reuma.2017.04.004 (epub 19 May 2017).

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of MedicineUniversity of Central Florida College of MedicineOrlandoUSA
  2. 2.DermSurgery AssociatesHoustonUSA

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