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REVIEW ARTICLE
Light and Laser Modalities in the Treatment of Cutaneous
Sarcoidosis: A Systematic Review
Ana Luiza LIMA, Steven GOETZE, Tanja ILLING and Peter ELSNER
Department of Dermatology, University Hospital Jena, University Hospital Jena, Jena, Germany
Sarcoidosis is a systemic non-caseating granuloma-
tous disease of unknown aetiology. Cutaneous mani-
festations are present in approximately 10–30% of the
patients with the systemic form. Therapy is indicated
in case of disabling symptoms, organ dysfunction or
cosmetically distressing manifestation. Despite diffe-
rent therapeutic possibilities, cutaneous sarcoidosis
remains exceptionally difficult to treat. Light and laser
therapy may be a promising alternative. In this syste-
matic review, we summarised the available treatments
according to the literature concerning light and laser
therapy for cutaneous sarcoidosis. Publications writ-
ten in English and German, published between January
1990 and July 2016 in the database PubMed, MEDLINE,
Embase, and Scopus were analysed. Light therapy with
intense pulsed light, photodynamic therapy, and ultra-
violet A light therapy, as well as laser therapy with pul-
sed dye laser, YAG laser, and Q-switched ruby laser
were described. The results are based on individual
case reports and small case series. Randomised con-
trolled studies are lacking.
Key words: cutaneous sarcoidosis; treatment; light therapy;
laser therapy.
Accepted Dec 15, 2017; Epub ahead of print Dec 15, 2017
Acta Derm Venereol 2018; 98: 481–483.
Corr: Ana Luiza Lima, Department of Dermatology, University Hospital
Jena, Erfurter Straße 35, DE-07743 Jena, Germany. E-mail: Ana.Lima@
med.uni-jena.de
S
arcoidosis is an idiopathic, non-caseating granulo-
matous disorder that may affect various organs (1).
Many patients are asymptomatic; however, in a small
group of patients the disease can be devastating and fatal.
The lungs are affected in more than 90% of the patients
with sarcoidosis, followed by lymph node, cutaneous,
and ocular manifestations (2). Skin involvement is pre-
sent in about 10–30% of patients with sarcoidosis and
often occurs at the onset of the disease (2, 3).
Half of all patients with sarcoidosis undergo sponta-
neous healing within 2 years (2). Treatment is indicated
in case of disabling symptoms, organ dysfunction or
cosmetically distressing manifestation (4).
Despite different therapeutic possibilities, cutaneous
sarcoidosis (CS) remains exceptionally difficult to treat,
presenting a variable response to the standard therapies
(5). Light and laser therapies have been proposed as a
promising alternative for therapy-resistant cases of CS
and for refractory lesions. This article systematically
reviews the use of physical modalities in the treatment
of CS.
MATERIALS AND METHODS
This systematic review was conducted in September 2016 based on
literature from PubMed, MEDLINE and Embase. The search was
restrained to reports published between January 1, 1990 and July
31, 2016 in English and German language. The terms ‘(phototh-
erapy) AND (cutaneous sarcoidosis)’, and ‘(laser) AND (cutaneous
sarcoidosis)’ were used for searching in PubMed. The articles were
also cross-referenced with the Scopus database. Manual search of
the references from retrieved articles was also performed.
In the initial search, a total of 31 articles were found. Reviews,
duplicated papers and papers that did not discuss the treatment
of CS were excluded, reducing the number of articles to 14. Six
additional articles were included through manual search, to give
a final total of 20 reports for analysis.
RESULTS
Light therapy
A total of 11 reports (17 patients) on light therapy treat-
ment of CS were found (Table SI 1 ).
Six patients underwent treatment with topical gel
psoralen 0.005% and UVA (PUVA) (6). Three patients
had a complete response and the other 3 showed a 50%
improvement of the lesions. The therapy was well tole-
rated and showed no adverse side-effects.
The two cases treated with UVA1 showed a therapy-
resistant sarcoidosis (7, 8). One patient underwent nearly
complete healing of all lesions and the other a conside-
rable improvement in the lesions. UVA1 therapy was
well tolerated.
A total of 7 patients were treated with photodynamic
therapy (9–14). For 5 patients topical aminolevulinic
acid (ALA) was used as photosensitizer. Two further
patients were photosensitized with topical methyl amino-
levulinate. Adverse effects described were: burning and
prickling sensation, erythema, oedema, hyperpigmenta-
tion; and superficial desquamation.
Two case reports analysed the efficacy of intense pulse
light (IPL) in the therapy of CS (15, 16). In one case,
the patient experienced marked improvement (15). The
https://www.medicaljournals.se/acta/content/abstract/10.2340/00015555-2864
1
This is a n open access article under the CC BY-NC license. www.medicaljournals.se/acta
Journal Compilation © 2018 Acta Dermato-Venereologica.
doi: 10.2340/00015555-2864
Acta Derm Venereol 2018; 98: 481–483