Correspondence (reply): In Reply

As our colleagues explained in detail, the topical treatment of cutaneous sarcoidosis constitutes a valuable therapeutic principle that complements systemic immunosuppression. Especially in isolated skin lesions that do not cause major impairment to the patient, it should be the primary therapeutic approach. The reminder of the psychosomatic component of the disease, which affects many patients with sarcoidosis, and the disproportionally high rates of associated depression is also important and appropriate. As Dr. Groger explained, there are hardly any scientific studies of this topic, and the association with sarcoidosis is largely not understood. I do, however, find the idea of vitamin D substitution as a possible therapeutic option problematic. Many patients with sarcoidosis tend to have hypercalcemia, which is affected by their diet, exposure to sunlight, and variations in the inflammatory activity of the sarcoidosis. A large proportion of patients subsequently develop kidney stones over the course of their disease. Even if the vitamin D concentration was found to be low in a sarcoid patient, regular monitoring of the calcium concentration is required once vitamin D substitution has been initiated. In this context it is worth to mention that the pathophysiological role of vitamin D in sarcoidosis is largely unknown.