Treatment and management for Sarcoidosis depends on the severity of the disease and of which part or organ it affected.
Patients who have neurosarcoidosis and cardiac involvement are given oral cortecosteroids if and when the disease does not respond to topical cortecosteroids treatments. Prednisone (30 mg/40mg) is given for about 3 months and should be taken daily which may be then reduced to a lower dosage and taken every other day soon after. Nonsteroidal anti-inflammatory drugs are also used for symptomatic relief.
Skin or cutaneous involvement may be treated with topical cortecosteroids or intralesional cortecosteroids (injectable cortecoisteroids). Triamcinolone acetonide in 2-10mg/mL is injected to patients every month but for severe skin lesions like lupus pernia, intralesional cortecosteroids may not be recommended since it leaves scarring of the tissue. Methotrexate, hydroxychloroquine and chloroquine are antimalarials that are commonly used to treat severe lesions of the skin.
Photodynamic therapy with methyl aminolevulinate and radiation therapy are also used in treating persistent cutaneous lesions. Photodynamic therapy or PDT is a procedure done to minimize damage of the lesions and prevent it from scattering or affecting healthy tissues. Photosynthesizing agents, light and oxygen are normally involved in this procedure. A 2 step procedure, PDT focuses on malignant and benign lesions.
Laser surgery is also done in treating lupus pernia and skin plaques. Some prefer surgical excision for small and large lesions for cheaper cost though keloidal scarring and hypertrophic is present.
There are other treatments that can be used for cutaneous sarcoidosis. To name a few, leflunomide, adalimumab, thalidomide, chlorambucil, oral isotretinoin and melatonin. These are some agents that can be used under doctor’s prescription.
Cortecoisteroids is the most common and considered to be the mos effective treatment for cutaneous lesions. While it is known to be as immunosuppressant in treating autoimmune disorders, prednisone also decreases inflammation. Methotrexate is an antemetabolite and antifolate agent that is used to patients who does not respond to steroids. Prolong use of Methotrexate is not advised. Chloroquinine Phosphate is an agent that works on both lungs and skin caused by Sarcoidosis but sometimes, adverse effects are noted.
Immunomodulatory agents like thalidomide suppresses the rapid production of TNF-alpha and deregulate cell adhesions that are involve in the migration of leukocytes.
Patients with Sarcoidosis in chronic stage needs hospital care and close monitoring. Respiratory difficulty, patients who developed infection with the use of cortecoisteroids or immunosuppressed patients may cause hospitalization. Further examinations are needed for them, patients with cutaneous diseases can be treated at home.
Frequent visit to the doctor is advised when treating sarcoidosis. Aftercare instructions are given to those who have been hospitalized. Opthalmologic examination is also required. Make sure to give brief history to the doctor during follow-ups. Physical examinations are done during this time. At some point chest X-ray will be advised making sure that the disease did not aggravate. For persistent sarcoidosis, pulmonary tests will also be requested. For malignant cutaneous disease, close monitoring and strict laboratory tests are done to prevent developing skin cancer.