Sarcoidosis and your skin: Causes

What causes sarcoidosis on the skin?

While scientists are still studying what causes sarcoidosis, they believe this disease starts when a trigger causes the immune system to overreact. This overreaction leads to inflammation, which causes the bumps, raised patches, and other signs of sarcoidosis on the skin.

Working as a firefighter or first responder may trigger sarcoidosis

A trigger can cause sarcoidosis to develop in any part of the body.

Researchers have a pretty good understanding of what can trigger cells in the immune system to overreact. Findings from studies indicate that many triggers are found in the workplace or home. Possible triggers include:

• Years spent around burning wood (e.g., wood-burning stove or fireplace)

• Working as a firefighter or emergency responder

• Metalworking

• Working in a navy yard or on an aircraft carrier

• Agriculture work

• Intense exposure to mold, mildew, bacteria, or viruses

• Psittacosis, a type of lung infection that birds carry

• Tattoo on your skin

Certain medications may also be a trigger. Some people who take medications, including antiretroviral therapy drugs, interferon, or a biologic develop a condition called drug-induced sarcoidosis. It usually goes away when the patient stops taking the medication and can return if the patient starts taking the medication again.

It’s unclear whether the medication triggers sarcoidosis or the non-cancerous lumps develop for another reason.

A trigger is thought to cause inflammation, which brings immune cells rushing in. As more immune cells gather, they form clumps. These clumps are the bumps and lumps that form in the skin and inside the body when someone has sarcoidosis. The medical name for these lumps and bumps is granulomas.

Researchers have learned that some people exposed to a trigger develop sarcoidosis, but others don’t.

For example, some first responders who worked at the World Trade Center site after 9/11 developed sarcoidosis. A study found that the first responders who developed sarcoidosis had certain variations in their genes. These variations were not found in the first responders who didn’t develop sarcoidosis.

It’s possible that triggers may vary from person to person. More research is needed to know whether this is true.

What increases risk of getting sarcoidosis?

Findings from studies suggest that you are more likely to develop sarcoidosis if you:

• Have a close blood relative who has sarcoidosis

• Live in Scandinavia or the United States

• Are Black and living in the United States

• Have certain variations in your genes

People of all ages and races get sarcoidosis

While some people have a greater risk of developing sarcoidosis, not everyone who has a higher risk develops this disease. And some people who don’t have a higher risk, get sarcoidosis.

This disease develops in people around the world and can begin at any age. Most people develop it between their 20th and 40th birthday. Another peak time for developing sarcoidosis is between 45 and 65 years of age.

If you think you may have sarcoidosis on your skin, it’s important to see a board-certified dermatologist for an accurate diagnosis. On the skin, sarcoidosis can look like one of many skin conditions.

To find out how dermatologists diagnose and treat this disease, go to Sarcoidosis and your skin: Diagnosis and treatment.

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References
Caplan A, Rosenbach MA, et al. “Cutaneous sarcoidosis.” Semin Respir Crit Care Med. 2020 Oct;41(5):689-99.

Cohen AF, Lhote R, et al. “Drug-induced sarcoidosis: An overview of the WHO pharmacovigilance database.” J Intern Med. 2020 Sep;288(3):356-62.

Imadojemu S, Rosenbach M. “Sarcoidosis of the skin.” JAMA Dermatol. 2022; 158 (12): 1464.

Jadotte YT, Abdel Hay R, et al. “Interventions for cutaneous sarcoidosis.” Cochrane Database Syst Rev. 2018 Aug 20;2018(8):CD010817.

Newman KL, Newman LS. “Occupational causes of sarcoidosis.” Curr Opin Allergy Clin Immunol. 2012 Apr;12(2):145-50.

Rosenbach MA, Wanat KA, et al. “Non-infectious granulomas.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008: 1644-50.

Written by:
Paula Ludmann, MS

Reviewed by:
Arturo R. Dominguez, MD, FAAD
Neelam Khan, MD, FAAD
Ivy Lee, MD, FAAD

Last updated: 3/24/23