Head and Neck Manifestations

Painless enlargement of the salivary glands occurs in 4% to 6% of patients with sarcoidosis. The parotid glands are most commonly enlarged, but any of the salivary glands can be affected. Sarcoidosis may mimic Sjogren's syndrome by causing symptoms and signs of dry eyes and mouth. The constellation of parotid enlargement with facial palsy, fever, and anterior uveitis is called Heerfordt's syndrome (30,33).

Sarcoidosis targets the upper respiratory tract in up to 18% of patients and is probably more frequently seen in the nose than the sinuses (34). Sinonasal disease may occur in isolation or may accompany manifestations in other organ systems. Nasal obstruction, rhinorrhea, nasal crusts, epistaxis, anosmia, pain in maxillary teeth, facial pain, headache, and intermittent dysphagia are the most common symptoms (34,35). Examination most frequently reveals erythematous, edematous, friable, hypertrophied mucosa and nasal crusts with studding by small pale or erythematous nodules. Also seen may be polyps of the middle meatus, turbinoseptal synechiae, and a saddle nose deformity. Imaging studies with computerized tomography (CT) of the head and neck may show mucosal thickening, sinusitis, and nodular lesions of the septum and inferior turbinates; however, these findings are relatively nonspecific (34,35).

Tonsillar involvement with sarcoidosis is rare. Sarcoidosis was present in 0.08% of tonsil and adenoid cases seen at the Armed Forces Institute of Pathology over 59 years (36). Most patients with tonsillar sarcoid present with a sore throat, but other complaints may include dysphagia or nasal obstruction.

Laryngeal disease occurs in about 1% of patients with sarcoidosis. Symptoms are nonspecific and include dysphagia, dyspnea, throat pain, dysphonia, hoarseness, obstructive sleep apnea, and cough. The most common findings of laryngeal sarcoidosis are diffuse symmetric enlargement of the supraglottic structures and turban-like thickening of the epiglottis. The sites of laryngeal involvement in decreasing order of frequency are the epiglottis, aryepiglottic folds and arytenoids, false vocal cords, true vocal cords, and subglottis. Radiographic studies may demonstrate an enlarged epiglottis (37,38).

Neuro-otologic manifestations of sarcoidosis are rare and occur in less than 1% of patients. Symptoms include sudden, asymmetric, sensorineural hearing loss, tinnitus, aural fullness, and dizziness. A diagnosis of neuro-otologic sarcoidosis is generally inferred from evidence of sarcoidosis in other tissue (39).

Ocular involvement occurs in 20% to 30% of patients with sarcoidosis and can affect any part of the eye or orbit; this is the presenting problem in about 5% of patients with this disease. Uveitis is the most frequent and early ocular feature of sarcoidosis (40). Common ocular findings include anterior uveitis, posterior uveitis, retinal vasculitis, intermediate uveitis, vitritis, and keratoconjunctivitis sicca. Other ocular manifestations are conjunctival nodules (Fig. 2A), iris nodules (Fig. 1F), lacrimal gland enlargement, dacryocystitis, scleritis, and orbital muscle involvement (30,33,40). Corneal disease is extremely rare (40).

The prevalence of neurologic involvement is 5% to 10%. Sarcoidosis can produce basilar lymphocytic meningitis leading to cranial nerve palsies (41,42), central diabetes insipidus, hydrocephalus, and hypothalamic hypopituitarism. CNS lesions tend to occur early in the course of the disease (30,33).

One-third of patients with sarcoidosis have palpable peripheral lymph nodes. The most frequently involved are the cervical nodes, with posterior cervical triangle nodes more common than anterior cervical triangle nodes. Adenopathy is mobile, nontender, and discrete, without ulceration or drainage. Other frequent sites of lymphadenopathy are axillary, epitrochlear, and inguinal (30,33).

Skin disease occurs in 20% to 25% of patients with sarcoidosis, including lesions on the head and neck. Sarcoid skin lesions may appear as a maculopapular eruption of the alae nares, lips, eyelids, forehead, posterior neck, and at sites of trauma; pink nodular facial lesions; and plaque-like lesions, such as lupus pernio, a violaceous discoloration of the nose, cheeks, chin, and ears (30,33). Other cutaneous manifestations outside the head and neck region include erythema nodosum; changes in old scars; alopecia; subcutaneous nodules; and psoriaform, hypopigmented, morpheaform, and rosacea-like lesions (30,33). The simultaneous development of erythema nodosum, hilar adenopathy, migratory polyarthralgias, and fever is referred to as Lofgren's syndrome and occurs primarily in women.

How To Deal With Rosacea and Eczema

How To Deal With Rosacea and Eczema

Rosacea and Eczema are two skin conditions that are fairly commonly found throughout the world. Each of them is characterized by different features, and can be both discomfiting as well as result in undesirable appearance features. In a nutshell, theyre problems that many would want to deal with.

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