Correspondence (letter to the editor): Topical Therapeutic Options Should Be Given Preference

Professor Prasse rightly emphasizes in her CME article (1) that in Caucasian people, the skin is affected by sarcoidosis in about 15% of cases. Some disease courses actually affect the skin only, and, according to more recent epidemiological data, these are not rare (2).

As there is thus far no treatment that has gained specific approval for sarcoidosis, and as the systemic therapies named in the article may cause serious adverse effects, we need to remember that for the treatment of cutaneous sarcoidosis alone, topical therapeutic options are available that have potentially fewer side effects. This is also true for phototherapeutic approaches, such as laser therapy, photodynamic therapy, topical PUVA therapy, and UV-A1 phototherapy. The latter was also mentioned in the German Dermatological Society’s recently published S1 guideline on UV phototherapy and photochemotherapy (3). In exclusively cutaneous forms of sarcoidosis, these therapeutic options should be used preferentially, in the sense of “Do No Harm,” even though their evidence level—similar to that of other therapeutic approaches in sarcoidosis—may be less than satisfactory.