Sarcoidosis is a condition characterized by the presence of granulomas – small beadlike patches of inflamed cells – that often appear in the lungs and adjacent lymph nodes. Sarcoidosis can also affect other tissues of the body including the muscles, eyes, and skin. While most individuals with sarcoidosis have no symptoms at all, sarcoidosis can cause long-term organ damage, such as the abnormal formation of fiber-like scar tissue in the lung. This actually distorts the structure of the lungs and can interfere with breathing. Those who have a variation of the condition, called Lofgren's syndrome, may have symptoms that include swollen lymph nodes, fever, painful, reddened nodules, and joint pain. Lofgren's syndrome is found more frequently in persons of Scandinavian, Irish, and Puerto Rican descent and it generally tends to clear up on its own within one to two years. The prevalence of sarcoidosis is higher in Blacks than Whites in the United States; about 36 in 100,000 Black Americans and 11 in 100,000 White Americans have the condition.
Signs and SymptomsMany individuals with sarcoidosis have no symptoms at all.
Some individuals with pulmonary (lung) sarcoidosis may experience the following signs and symptoms:
- Fatigue and weakness
- Weight loss
- Shortness of breath or chest pain
- Dry cough
- Enlarged lymph nodes around the lungs
- Enlarged lymph nodes
- Red-purple inflamed areas on the legs
- Scaly rash
- Swelling and pain in the ankles and knees
- Infections of the eye, including conjunctivitis
- Facial paralysis
- Enlarged or inflamed liver
- Kidney stones
CausesAlthough the precise cause of sarcoidosis is unknown, some scientists speculate that an exaggerated defense reaction against some event or substance perceived as a threat by the immune system may trigger the condition. Other researchers have proposed that the condition may be inherited, caused by an infection, or caused by inhaled allergens or toxins found in the environment. The National Heart, Lung, and Blood Institute is currently conducting a study to determine the cause of the condition.
Risk FactorsSarcoidosis is found throughout the world within almost all races and ages and in both sexes, however it is most common among the following:
- Individuals of Scandinavian, Irish, African, or Puerto Rican descent
- Individuals in their 30s or 40s
DiagnosisAlthough many individuals with sarcoidosis experience no symptoms of the condition, the following tests may help a physician diagnose the condition:
- Chest X ray
- Blood tests
- CT scan, MRI, or other imaging tests
- Eye exam
- EKG (electrocardiogram)
Treatment ApproachAbout half of all individuals with sarcoidosis recover spontaneously and do not need treatment. For those who do not recover spontaneously, symptom relief and prevention of complications are often provided by medications such as corticosteroids, which reduce swelling, rashes, pain, fever and lung problems. Some lifestyle changes, including a diet low in calcium or avoidance of vitamin D and sunlight, may help control some of the complications of the condition, such as kidney stones or other damage. While complementary therapies for sarcoidosis have not been well studied, anecdotal reports suggest that melatonin and homeopathy may provide symptom relief and improve general well-being.
LifestyleEating a diet low in calcium and vitamin D may relieve or help prevent two of the complications of sarcoidosis, hypercalcemia (an abormally high amount of calicium in the blood) and kidney disease. A physician can provide advice on how to cut calcium out of the diet.
Avoiding sunlight, which is converted to vitamin D by the body, is also recommended.
Quitting smoking can ease lung symptoms.
MedicationsCorticosteroids such as prednisone, prescribed by a physician, are the most effective medications for reducing inflammation associated with sarcoidosis. Oral corticosteroids can have some serious side effects if taken in high doses for long periods, including high blood pressure, diabetes, peptic ulcers, tuberculosis, or hirsutism (excessive hair growth). If an individual is at risk for these problems, a physician will likely advise regular check-ups and tests.
Other medications for sarcoidosis can include:
- Methotrexate – for severe sarcoidosis; may cause liver damage
- Antimalarial drugs such as hydroxychloroquine – for disfiguration of the skin; may be toxic to the eyes
Surgery and Other ProceduresSurgery, such as a lung or heart transplant, is only necessary in extreme cases.
Nutrition and Dietary SupplementsMelatonin: For individuals with chronic sarcoidosis who do not respond to corticosteroids, preliminary studies suggest that the brain hormone melatonin may be an effective alternative. In one study, individuals with sarcoidosis who did not respond to corticosteroid therapy experienced the following improvements after taking 20 mg of melatonin per day for 4 to 12 months:
- Improved breathing
- Decreased lymph node swelling
- Normalization of blood tests (indicate improvement in the condition)
HomeopathyA few case reports suggest that homeopathic remedies may improve the general well-being of individuals with sarcoidosis. An experienced homeopath can prescribe a regimen for treating sarcoidosis that is designed specifically for each individual. The primary remedies used by individuals who reported improvements in their symptoms include:
- Tuberculinum bovinum
- Leuticum (Syphilinum)
- Arsenicum album
PregnancySarcoidosis does not affect fertility. Symptoms may improve in up to 65% of pregnant women who once had the condition, while 5% may experience worsening of symptoms. Postpartum symptom flare-ups may also occur within the first 6 months. Pregnant women with sarcoidosis should avoid exposure to X rays and toxic medications such as methotrexate.
Prognosis and ComplicationsComplications from sarcoidosis usually occur in only the most serious cases, and can include heart, kidney, and lung damage. Ulcers, diabetes, high blood pressure, and infections, such as tuberculosis, may result from long-term use of corticosteroids.
The prognosis for most individuals with sarcoidosis is good. Only 15% of those with sarcoidosis experience symptoms that progressively worsen and 5% develop severe lung problems, which increases the risk of death. Almost half of all individuals with sarcoidosis spontaneously improve without any therapy, and treatments used today, such as coritcosteroids, are often successful in helping to ease the inflammation associated with the condition.
Antony F, Layton AM. A case of cutaneous acral sarcoidosis with response to allopurinol. Br J Dermatol. 2000;142(5):1052-1053.
Cagnoni ML, Lombardi A, Cerinic MC, Dedola GL, Pignone A. Melatonin for treatment of chronic refractory sarcoidosis [letter]. Lancet. 1995;346(4):1229-1230.
Cecil RI, Plum F, Bennett JC, eds. Cecil Textbook of Medicine, 20th ed. Philadelphia, Pa: W.B. Saunders; 1996.
Corticosteroids. NMIHI. Accessed at http://drugs.nmihi.com/corticosteroids.htm on December 12, 2018.
Connolly JW. Sarcoidosis. Br Homeopath J. 1987;76:202-203.
Dambro MR. Griffith's 5-Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins, Inc.; 1999.
Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine, 14th ed. New York, NY: McGraw-Hill; 1998:1922-1929.
Feldman M, ed. Sleisenger & Fordtran's Gastrointestinal and Liver Disease, 6th ed. Philadelphia, Pa: W.B. Saunders; 1998.
Georgiou S, Monastirli A, Pasmatzi E, Tsambaos D. Cutaneous sarcoidosis: complete remission after oral isotretinoin therapy. Acta Derm Venereol (Stockh). 1998;78(6):457-459.
Goroll AH, ed. Primary Care Medicine, 3rd ed. Philadelphia, Pa: Lippincott-Raven Publishers; 1995.
Il 'kovich MM, Novikova LN, Baranova OP. Weight-reducing diet therapy in the combined treatment of pulmonary sarcoidosis [in Russian]. Ter Arkh. 1996;68(3):83-87.
Koopman WJ, ed. Arthritis and Allied Conditions, 13th ed. Baltimore, MD: Williams & Wilkins, Inc.; 1997.
Newman LS, Rose CS, Maier LA. Sarcoidosis. N Engl J Med. 1997;336(17):1224-1234.
Paramothayan NS, Jones PW. Corticosteroids for pulmonary sarcoidosis. Cochrane Database Syst Rev. 2000;No. 2:CD001114.
Prednisone. NMIHI. Accessed at http://www.nmihi.com/p/prednisone.html on December 12, 2018.
Rakel RE, ed. Conn's Current Therapy, 51st ed. Philadelphia, Pa: W.B. Saunders; 1999.
Sarcoidosis. NMIHI. Accessed at http://www.nmihi.com/s/sarcoidosis.htm on December 12, 2018.
Sarcoidosis Overview. Cleveland Clinic. Accessed at https://my.clevelandclinic.org/ on September 19, 2018.
Sarcoidosis: Causes, symptoms, and treatment. MedicalNews. Accessed at https://www.medicalnewstoday.com/ on September 19, 2018.
Tani K, Ogushi F, Huang L, et al. CD13/aminopepetidase N, a novel chemoattractant for T lymphocytes in pulmonary sarcoidosis. Am J Respir Crit Care Med. 2000;161(5):1636-1642.
Waldinger TP, Ellis CN, Quint K, Voorhees JJ. Treatment of cutaneous sarcoidosis with isotretinoin. Arch Dermatol. 1983;119(12):1003-1005.
Weinberg I, Vasiliev L, Gotsman I. Anti-dsDNA antibodies in sarcoidosis. Semin Arthritis Rheum. 2000;29(5):328-331.