Sarcoidal foreign body reactions and their association with systemic sarcoidosis

Summary: Abstract Body: This study investigates the incidence of sarcoidal foreign body reactions (SFBRs) and their association with systemic sarcoidosis (SS) in affected individuals. We conducted a single-center, retrospective chart review of patients 18 years and older with biopsy-proven sarcoidal granulomatous dermatitis (SGD) from 2016 to 2024. Patient demographics, lesion characteristics, histopathological findings, and evaluation for SS were reviewed. Patients with a known history of sarcoidosis preceding their biopsy were excluded. Among 45 cases of SGD, 10 (22%) were associated with foreign materials. Carbon tattoo pigment was most frequently identified (60%), with other materials, including silicone cosmetic filler, asphalt, and anabolic steroid contaminants. Histopathologic evaluation most often revealed granulomatous dermatitis, sarcoidal type, associated with foreign material. Lesions presented as papules, nodules, and plaques and were most frequently located on the arms (41.7%). Of the 10 patients with SFBRs, 8 (80%) were recommended to undergo further work-up for SS, which included bloodwork, chest imaging, and/or referrals to specialists, including pulmonary, cardiology, rheumatology, or ophthalmology. Extracutaneous involvement suggestive of SS was identified in 3 (38%) of these 8 patients. Although sarcoidal granulomatous reactions in response to traumatic inoculation with foreign bodies have been documented, these lesions were primarily limited to the skin. Our findings suggest that SFBRs may represent an initial manifestation of SS and highlight the need for a thorough diagnostic work-up. Given that systemic involvement may present later, longitudinal studies are necessary to further elucidate the association between SFBRs and SS. Nicole Schiraldi^{1, 2}, Richard Rookwood^{1, 2}, Tian Zhu^{1, 2}, David Ciocon^{2, 1} 1. Dermatology, Albert Einstein College of Medicine, Bronx, NY, United States. 2. Dermatology, Montefiore Medical Center, New York, NY, United States. Clinical Research: Epidemiology and Observational Research