Therapy for extrapulmonary sarcoidosis.

The treatment of extrapulmonary sarcoidosis has to be adapted to the various organs involved. No treatment is necessary for most asymptomatic individuals. In some cases, topical therapy is sufficient to control problems, especially skin and eye involvement. Systemic therapy usually starts with corticosteroids. However, for chronic forms of the disease, steroid sparing alternatives such as methotrexate and hydroxychloroquine are useful. In some neurologic and cardiac cases, the response to corticosteroids is limited. In that case, alternatives are sought for these refractory patients. Drugs that inhibit tumor necrosis factor may prove useful in these patients. Among the new anti-tumor necrosis factor drugs are thalidomide and infliximab, an antibody to tumor necrosis factor.