P028 Cutaneous sarcoidosis in a child with type 1 diabetes: dermoscopic findings and clinical correlation

Abstract

A 11-year-old girl with poorly controlled type 1 diabetes (HbA1c > 10% for 4 years) presented with a 6-month history of erythematous–orange atrophic plaques on the right leg, studded with telangiectasias. Dermoscopic examination revealed grouped translucent orange globular structures, linear vessels of variable calibre, central whitish scar-like areas, and shiny white streaks. Follicular keratotic plugs were also present. Histopathology demonstrated non-necrotizing epithelioid and giant cell granulomas, confirming cutaneous sarcoidosis. Systemic investigations were normal, suggesting isolated cutaneous disease. Treatment with potent topical corticosteroids resulted in marked improvement. Paediatric sarcoidosis is rare, with an incidence of 0.22 to 0.29 per 100 000 children per year. Cutaneous manifestations occur in 77% of young children and 24–40% of older children. The dermoscopic features observed are characteristic of cutaneous sarcoidosis. Grouped translucent orange globular structures represent the most consistent sign, present in 100% of cases. Linear vessels of variable calibre are observed in 97% of cases. Central whitish scar-like areas and shiny white streaks are present in 67% and 77% of cases, respectively. Follicular keratotic plugs, observed in 38% of cases, constitute an additional diagnostic element. The combination of these dermoscopic signs should strongly suggest the diagnosis of cutaneous sarcoidosis and justify histopathological confirmation. Dermoscopy plays an important role in the diagnostic orientation of paediatric cutaneous sarcoidosis, with grouped translucent orange globular structures associated with linear vessels being highly suggestive of this diagnosis.