Sarcoidosis is a chronic multisystem disease characterized by the formation of noncaseating granulomas. Tumour necrosis factor (TNF)-alpha is central to granuloma formation. Anti-TNF-alpha agents have shown success in the treatment of sarcoidosis. We report response to adalimumab in a patient with recalcitrant cutaneous sarcoidosis.A 43-year-old woman presented in 2004 with a 1-year history of disfiguring centrofacial cutaneous sarcoidosis on a background of stage 1 asymptomatic pulmonary sarcoidosis. Her skin disease progressed despite hydroxy-chloroquine 400 mg/200 mg on alternate days and minocycline 100 mg/day. She also had six smaller plaques over the left zygoma, shins and arms (Fig. la).Haematology investigations, biochemistry profiles and serum angiotensin-converting enzyme concentration were normal. Chest radiography found bihilar lymphadenopa-thy. Pulmonary function tests gave a predicted diffusion capacity of 76%. Mantoux test to two tuberculin units (2 TU) was negative.
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