Mind the Gap atlas
Sarcoidosis (cutaneous) on Black skin
Key cue: Violaceous or hyperpigmented papules and plaques on face, scalp, old scars, or tattoos — 'scar sarcoidosis' is particularly common in Black patients.
Sarcoidosis is a multisystem granulomatous disease with markedly higher incidence in Black Americans (annual incidence ~35-40 per 100,000 vs 8-10 per 100,000 in white Americans; Rybicki BA Am J Epidemiol 1997). Black patients also have more severe lung involvement, more frequent cutaneous and ocular involvement, and higher mortality.
What it actually looks like
Textbook says
Classic cutaneous forms: erythema nodosum — tender red-purple shin nodules (part of Löfgren syndrome, generally self-limited); lupus pernio — indurated violaceous plaques on the nose, cheeks, and ears; sarcoid papules and plaques — smooth red-brown lesions; scar sarcoidosis — new infiltration of old scars or tattoos.
On Black skin
J Am Acad Dermatol skin-of-colour series note that cutaneous sarcoidosis is both more common and more varied in appearance on Black skin:
- Papules and plaques often appear violaceous, hyperpigmented, or dusky brown rather than red-brown. Diascopy (glass pressure) reveals a characteristic 'apple-jelly' yellow-brown colour in the underlying granuloma — useful on any skin tone.
- Lupus pernio — indurated plaques on the nose, cheeks, and ears — is strongly associated with chronic/severe sarcoidosis and more common in Black women. Under-treatment leads to permanent disfigurement.
- Scar/tattoo sarcoidosis — infiltration of existing scars (including keloids, piercing scars, or tattoos) — is a relatively specific finding and occurs at higher rates in Black patients.
- Erythema nodosum is less common in Black patients with sarcoidosis than in white patients; instead, chronic papular, annular, or hypopigmented patches are more typical presentations.
- Hypopigmented sarcoidosis — white to skin-coloured patches on the trunk and limbs — is a distinct presentation seen almost exclusively in Black skin and is a major pitfall (often mistaken for vitiligo).
What to look for
- Persistent red-brown to violaceous papules or plaques on face, scalp, or trunk.
- New firm infiltration of an old scar, piercing site, or tattoo.
- Hypopigmented patches, particularly on the trunk, that don't itch.
- Associated findings: shortness of breath or cough (lung sarcoidosis), eye pain or blurred vision (ocular), arthralgias, fatigue, facial nerve weakness, palpable lymph nodes.
Urgent — see a clinician within 24 hours
See a dermatologist or primary-care clinician within 1-2 weeks for persistent suspicious skin lesions. A punch biopsy showing non-caseating granulomas is diagnostic. If you have suspicious skin findings, ask for a chest X-ray, pulmonary function tests, an ophthalmology exam (slit lamp), and basic labs (calcium, ACE level, CBC). Go to the ER for severe shortness of breath, chest pain, vision changes, seizure, or severe fatigue with fever.
Common misdiagnosis
Hypopigmented sarcoidosis on Black skin is frequently misdiagnosed as vitiligo, tinea versicolor, or post-inflammatory hypopigmentation — missing an opportunity for systemic evaluation. Scar sarcoidosis is sometimes mistaken for keloid recurrence. When suspicious skin lesions persist > 2 months, a biopsy is the answer.
See it for yourself — curated external imagery
We don't host clinical photos here. The links below go to peer-reviewed or open-access sources (Mind the Gap, DermNet NZ, PubMed Central, and similar). Each opens in a new tab.
- Mind the Gap handbook — sarcoidosis plate.
- DermNet NZ — Cutaneous sarcoidosis — including lupus pernio, hypopigmented, and scar-type images.
- PMC — Cutaneous sarcoidosis in African-Americans (J Drugs Dermatol 2018, open access).
- Foundation for Sarcoidosis Research — patient education and photo gallery.
References
- Rybicki BA, Major M, Popovich J Jr, Maliarik MJ, Iannuzzi MC. Racial differences in sarcoidosis incidence: a 5-year study in a health maintenance organization. Am J Epidemiol. 1997;145(3):234-41. PMID: 9012596.
- Mañá J, Marcoval J. Skin manifestations of sarcoidosis. Presse Med. 2012;41(6 Pt 2):e355-74. PMID: 22595777.
- Yanardağ H, Pamuk ON, Karayel T. Cutaneous involvement in sarcoidosis: analysis of the features in 170 patients. Respir Med. 2003;97(8):978-82. PMID: 12924525.
- Haimovic A, Sanchez M, Judson MA, Prystowsky S. Sarcoidosis: a comprehensive review and update for the dermatologist: part I. Cutaneous disease. J Am Acad Dermatol. 2012;66(5):699.e1-18. PMID: 22507585.
Medical disclaimer
Educational content only. This is not a substitute for in-person evaluation. If you are worried about yourself or someone you love, see a clinician — and if you are concerned about an emergency sign described here, call 911 or your local emergency number. We do not host clinical imagery; the external references are for reader self-education and are not owned by or affiliated with Black Health.