Topikal Takrolimus Tedavisine Çok Iyi Yanit Veren Skar Sarkoidozu/ Scar Sarcoidosis with an Excellent Response to Treatment with Topical Tacrolimus

Özet. Büyük taklitçilerden birisi olan kutanöz sarkoidoz hala patogenezi tam olarak anlasilamamis ve klinikte çok farkli sekillerde karsimiza çikabilen bulmaca gibi bir klinik antitedir. Elli sekiz yasinda kadin hasta 35 yil önce olusan skarlarda 5 aydir ortaya çikan kabarma yakinmasi ile poliklinigimize basvurdu. Dermatolojik muayenede farkli bölgelerdeki skarlarda kabariklik seklinde lineer bakir kirmizimorumsu plaklar ve diaskopide elma jölesi bulgusu tespit edildi. Alinan punch biyopsinin histopatolojik incelemesinde non-kazeifiye multifokal granulomatöz yapilar tespit edildi. Olguya yapilan incelemeler sonucunda evre I akciger tutulumlu kutanöz skar sarkoidozu tanisi konuldu. Baslanan topikal takrolimus tedavisi ile altinci haftadaki kontrolde lezyonlarda belirgin gerileme gözlendi ve 5 ay sonra nüks saptanmadi. Eski skarlarda infiltrasyon ile basvuran hastalarda skar sarkoidozu akla gelmesi gereken bir tanidir ve mutlaka histopatolojik inceleme ile dogrulanmalidir. Benzer hastalar sistemik tutulum açisindan ayrintili inceleme yapildiktan sonra kutanöz sarkoidoz için literatürde genelde bildirilen sistemik kortikosteroid yerine topikal takrolimus ile güvenli ve etkili bir sekilde tedavi edilebilir. (Türk derm 2011; 45: 219-21). Anah tar Ke li me ler: Sarkoidoz, skar, takrolimus, tedavi, topikal. Summary. As a great imitator, sarcoidosis is a puzzling clinical entity that can present with diverse clinical pictures and its pathogenesis is still unknown. A 58-year-old woman applied to our outpatient clinic with a complaint of swelling of scars in her body present for 5 months and her scars were present for 35 years. On dermatological examination, enlargement of scars was observed in different areas of the patient's body and these were seen as linear copper red-violaceous plaques with apple-jelly sign on diascopy. Histopathological examination of a punch biopsy specimen revealed non-caseating granulomatous structures. Following detailed examinations, the case was diagnosed as having scar sarcoidosis with stage I lung involvement. Significant regression of lesions was detected at 6th week follow-up examination after commencement of topical tacrolimus treatment and there was not any relapse of the lesions after 5 months of treatment. The diagnosis of scar sarcoidosis should be remembered in cases who apply with the finding of infiltration of old scars and this diagnosis must be confirmed by using histopathological examination. Instead of using systemic corticosteroids, which is reported frequently for the treatment of cutaneous sarcoidosis in the literature, such cases can be treated safely and effectively with topical tacrolimus following a detailed examination for detection of systemic involvement. (Turk derm 2011; 45: 219-21). Key Words: Sarcoidosis, scar, tacrolimus, therapy, topical.

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