Sarcoidosis is a great mimicker. It boasts a wide array of clinical presentations, including a papular variant, as seen here. Note the last image—this hallmark of presentation can be the development of papules within a tattoo with background erythema.

Due to various presentations across skin types, sarcoidosis may be difficult to distinguish from deep fungal infections, cutaneous tuberculosis, leprosy, or CTCL. Diascopy may be utilized to discern an “apple jelly” color which differentiates sarcoidosis from the various diseases it may mimic.

Annular sarcoidosis can be appreciated in light to medium skin tones due to the advancing serpiginous erythematous border, as seen here. Notice the last image—the presence of sarcoid is distinguished by mildly erythematous to hypopigmented papules coalescing into ill- defined plaques.

Sarcoidosis in a darker skin tone is differentiated by mildly erythematous hypopigmented papules in contrast to erythematous hyperpigmented papules seen in lighter skin tones.

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