15 Nose and Nasal Skin Changes Associated With Rosacea and Autoimmune Conditions

11. Sarcoidosis and Granulomatous Nasal Infiltration

Sarcoidosis, a multisystem granulomatous disorder of unknown etiology, can present with distinctive nasal manifestations that may be among the earliest signs of systemic disease, characterized by granulomatous infiltration of nasal tissues that can cause both functional and cosmetic concerns. The nasal involvement in sarcoidosis typically presents as chronic nasal congestion, crusting, epistaxis, and sometimes visible external nasal lesions that appear as violaceous or erythematous papules, plaques, or nodules. These lesions result from the formation of non-caseating granulomas within the nasal mucosa and skin, composed of epithelioid cells, giant cells, and lymphocytes that create characteristic inflammatory infiltrates visible on histopathologic examination. The granulomatous inflammation can affect various structures within the nose, including the nasal mucosa, turbinates, septum, and external nasal skin, potentially leading to nasal obstruction, anosmia, and structural changes if left untreated. Lupus pernio, a specific form of chronic cutaneous sarcoidosis, has a predilection for the nose and can cause significant disfigurement through chronic granulomatous inflammation that creates violaceous, indurated plaques with a characteristic appearance. The diagnosis of nasal sarcoidosis requires correlation of clinical findings with histopathologic evidence of non-caseating granulomas, often supported by elevated serum angiotensin-converting enzyme levels, abnormal chest imaging, and exclusion of other granulomatous conditions. Treatment typically involves topical or systemic corticosteroids, with additional immunosuppressive agents sometimes required for refractory cases or to minimize steroid-related side effects.