Development of cutaneous sarcoidosis to permanent eyebrow makeup procedure

Abstract

The article summarizes the data on historical aspects, epidemiology, etiopathogenesis, clinical picture, diagnosis and treatment of skin sarcoidosis. Sarcoidosis is a chronic multisystem disease from the group of granulomatoses of unknown etiology, the morphological feature of which is the development of epithelioid cell granulomas without caseous necrosis with the processes of dystrophy, destruction and fibrosis in the tissues of various organs. Diagnosis and differential diagnosis of sarcoidosis are based on clinical examination, changes in laboratory data, X-ray methods and skin biopsy. The differential diagnosis includes many dermatoses, including tuberculoid type of leprosy, tuberculous lupus, lichen planus, annular granuloma, etc. In the treatment of sarcoidosis of the skin, corticosteroid drugs are used, including prolonged action. In case of resistance or contraindications, synthetic antimalarial and immunosuppressive agents are prescribed. According to the literature, cases of granulomatous reactions after permanent makeup procedures have become more frequent. The tattoo procedure is widespread and considered to be safe, but adverse reactions, particularly sarcoidosis of the skin, may develop. The etiology of sarcoidosis has been studied for more than 150 years and remains poorly understood until now. There are increasingly frequent reports in the literature about the development of immune granulomatous inflammation reactions after a numerous of cosmetic procedures, such as tattooing, botulinum toxin A injection, hyaluronic acid injections, permanent makeup, biorevitalization, facial modeling fillers, blepharoplasty. The increasing number of cases of skin sarcoidosis due to cosmetological manipulations is the subject of great scientific interest, and the growth of publications on this topic is an evidence of modern etiopathogenetic mechanisms of the disease development. Here is our clinical observation of skin sarcoidosis without systemic manifestations in a 54-year-old patient after permanent eyebrows make-up procedure outside the medical organization, without prior examination and lack of follow-up (the skin process is subacute; polymorphism of the rash is noted; rashes on the skin in the eyebrow area are represented by merging papules, foci correspond to the area of pigment injection). According to the results of physical, laboratory and instrumental studies, many epithelioid cell granulomas without caseous necrosis were found. The patient received a course of intraocular pricking with a prolonged glucocorticoid drug (Betamethasone suspension, No. 5), which led to a complete regression of rashes. Recommendations for the removal of pigment are given. In order to prevent infection and minimize the risks of complications, a high level of qualification of a dermatocosmetologist working in a specialized medical institution is a prerequisite for permanent makeup.