Refractory Cutaneous Lichenoid Sarcoidosis Treated with Tranilast

The document reports a successful treatment of lichenoid cutaneous sarcoidosis in a 76-year-old Japanese man using tranilast, an antiallergic drug. The patient's skin condition was refractory to conventional treatments, including potent topical corticosteroids and psoralen plus ultraviolet A light (PUVA) phototherapy, for over a year. After starting oral administration of tranilast at 300 mg per day, the skin lesions improved significantly and remitted after 5 months, leaving only pigmentation. Histologic examination had previously confirmed a noncaseating necrotizing granulomatous infiltrate in the skin, and other potential diagnoses such as generalized granuloma annulare and infectious granulomas were ruled out. The case suggests that tranilast may be a reasonable treatment option for lichenoid cutaneous sarcoidosis that does not respond to conventional therapy.