Cutaneous granulomas after cosmetic eyebrow micropigmentation as a potential marker of systemic sarcoidosis: a case report

Sarcoidosis is a systemic granulomatous disease of unknown etiology, characterized by the presence of non-caseating granulomas affecting multiple organs, particularly the lungs and skin. Cutaneous manifestations occur in up to 30% of cases and may represent the initial presentation. The appearance of lesions over tattoos or micropigmentation sites has been reported as a possible trigger in predisposed individuals. We report the case of a 54-year-old female patient who developed bilateral eyebrow edema and papules 1½ years after cosmetic micropigmentation. Histopathology revealed sarcoid-type granulomatous dermatitis. Further investigation identified pulmonary involvement and elevated angiotensin-converting enzyme levels, confirming systemic sarcoidosis. The patient showed partial response to corticosteroids and various topical and systemic treatments, with improvement after methotrexate and later azathioprine introduction. This case highlights the importance of considering systemic sarcoidosis in patients presenting with granulomatous reactions in cosmetic tattoos and reinforces the need for systemic screening in such presentations.