Understanding Lupus Pernio (Sarcoidosis of the Nose)
Understanding Lupus Pernio (Sarcoidosis of the Nose)
What is Lupus Pernio?
Lupus pernio is a chronic form of cutaneous sarcoidosis, most commonly affecting the nose, cheeks, and ears. It presents as red, swollen, sometimes violaceous (almost purple) plaques or nodules, often with visible blood vessels (telangiectasia). Over time, the affected area can become enlarged and distorted, leading to significant cosmetic and emotional impact.
While sarcoidosis can involve internal organs, lupus pernio is limited to the skin but can be particularly stubborn and resistant to standard treatments.
What Causes It?
The exact cause of sarcoidosis is unknown, but it involves an overactive immune response, leading to clusters of inflammatory cells (granulomas) forming in the skin and/or other tissues.
Standard Treatments:
Systemic Therapy:
Corticosteroids (oral)
Immunosuppressive agents (methotrexate, azathioprine, hydroxychloroquine, infliximab)
Topical/Intralesional Therapy:
Potent topical steroids
Calcineurin inhibitors - tacrolimus
Intralesional steroid injections
These aim to reduce inflammation and halt progression, but results can vary, and side effects often limit long-term use.
Advances in Laser Treatment:
For patients who do not respond well to medical treatments—or who are left with persistent redness, swelling, and telangiectasia—vascular laser therapy has emerged as an effective option. The pulsed dye laser (PDL) specifically targets the abnormal blood vessels and reduces redness and thickening.
Case Example:
This lovely lady had severe lupus pernio of the nose, with marked redness, visible vessels, swelling, and distortion of the nasal contour. The emotional impact of this was devastating having a huge impact on her confidence and quality of life.
After limited improvement on medical treatments, I implemented
Pulsed Dye Laser: to reduce blood vessels and redness.
· Intralesional Steroid Injections: to shrink granulomatous inflammation.
These treatments were done in the same session.
Over a 12 month period with 4 treatment sessions, we saw gradual remodeling of her nose—restoring a more natural appearance, both in colour and shape. Importantly, her results have remained stable with ongoing monitoring.
What’s the Takeaway?
Lupus pernio is a challenging condition, but today we have a growing toolbox of treatments that can make a meaningful difference. A combination of medical and laser therapy often offers the best results, especially when tailored to the individual’s needs.
If you are dealing with persistent skin redness, swelling, or a diagnosis of lupus pernio, we welcome you to book a consultation to explore your treatment options.
Actual patient of Dr Welsh after 4 sessions of a combination treatment of intralesional steroid and pulsed dye (V beam) laser