Surreal eye with scar constellation representing scar sarcoidosis.

Scar Sarcoidosis: When Your Scars Tell a Story

Samir D’Costa in Health & Wellness December 2025 • 4 min read.

"Unveiling the rare recurrence of orbital sarcoidosis in scar tissue and what it means for your health."

Sarcoidosis, a disease characterized by the formation of granulomas (clumps of inflammatory cells) in various organs, can manifest in unexpected ways. While it commonly affects the lungs and lymph nodes, sarcoidosis can also impact the skin, eyes, and other parts of the body. One particularly rare and intriguing presentation is scar sarcoidosis, where the disease recurs within pre-existing scar tissue.

Imagine undergoing surgery or experiencing an injury, only to find that years later, the resulting scar becomes inflamed and symptomatic. This is the reality for individuals with scar sarcoidosis, a condition that poses diagnostic and treatment challenges for healthcare professionals. The recurrence of sarcoidosis in scar tissue can occur spontaneously or following certain triggers, such as the cessation of immunosuppressant medications.

This article explores a fascinating case study of orbital sarcoidosis recurring in cutaneous scar tissue after the discontinuation of adalimumab, an immunosuppressant drug. By examining the clinical presentation, diagnostic workup, and treatment strategies employed in this case, we aim to shed light on the complexities of scar sarcoidosis and its implications for patient care.

What is Scar Sarcoidosis and Why Does It Occur?

Surreal eye with scar constellation representing scar sarcoidosis.

Scar sarcoidosis is a cutaneous manifestation of sarcoidosis that specifically affects scar tissue. It is relatively uncommon, accounting for an estimated 6-14% of all cutaneous sarcoidosis cases. The exact mechanisms underlying scar sarcoidosis remain unclear, but several factors may contribute to its development.

Prior Injury or Surgery: Scar tissue forms as part of the body's natural healing process following injury, surgery, or other trauma. The altered tissue environment within scars may create a conducive environment for granuloma formation in susceptible individuals.
Immune Dysregulation: Sarcoidosis is believed to be an immune-mediated disorder characterized by abnormal immune responses and inflammation. In scar sarcoidosis, immune cells may target scar tissue, triggering granuloma formation and inflammation.
Medication Changes: In some cases, scar sarcoidosis may occur or worsen following changes in medication regimens, particularly the discontinuation of immunosuppressant drugs. These medications help suppress the immune system and prevent excessive inflammation. When they are stopped, the underlying immune dysregulation may resurface, leading to sarcoidosis recurrence in scar tissue.

Prior Injury or Surgery, Immune Dysregulation, Medication Changes

Several factors can influence its development, including prior injury or surgery, immune dysregulation, and medication changes. Understanding these potential causes is crucial for accurate diagnosis and management.

The Importance of Recognizing Scar Sarcoidosis

Scar sarcoidosis presents a unique diagnostic and therapeutic challenge for healthcare professionals. Its rarity and variable clinical presentation can lead to delays in diagnosis, potentially resulting in unnecessary suffering and complications for patients. By raising awareness of scar sarcoidosis and promoting early recognition, we can improve patient outcomes and quality of life.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1111/ceo.13441, Alternate LINK

Title: Periocular Scar Sarcoidosis

Subject: Ophthalmology

Journal: Clinical & Experimental Ophthalmology

Publisher: Wiley

Authors: Tess G. Ryan, David S. Curragh, Dinesh Selva

Published: 2018-12-10

Everything You Need To Know

What is scar sarcoidosis, and how does it differ from typical sarcoidosis?

Scar sarcoidosis is a rare cutaneous manifestation of sarcoidosis, a condition where the disease recurs specifically within pre-existing scar tissue. Unlike typical sarcoidosis, which commonly affects organs like the lungs and lymph nodes, scar sarcoidosis localizes to areas of the body where scars are present, such as the skin. This makes its diagnosis and treatment particularly challenging, as it presents a unique clinical scenario. It involves the formation of granulomas, similar to sarcoidosis affecting other organs but specifically within the altered tissue environment of scars.

What are the key factors that might cause scar sarcoidosis?

Several factors contribute to the development of scar sarcoidosis. Firstly, prior injury or surgery is a significant factor because the altered tissue environment within scars can be conducive to granuloma formation. Secondly, immune dysregulation plays a crucial role, as sarcoidosis is an immune-mediated disorder. In scar sarcoidosis, immune cells may target scar tissue, causing inflammation and granulomas. Lastly, changes in medication, particularly the discontinuation of immunosuppressant drugs like adalimumab, can trigger or worsen scar sarcoidosis by allowing the underlying immune dysregulation to resurface.

How can changes in medication, such as stopping adalimumab, affect someone's scar sarcoidosis?

Discontinuing immunosuppressant drugs, like adalimumab, can significantly impact scar sarcoidosis. Adalimumab helps suppress the immune system and prevents excessive inflammation. When it's stopped, the underlying immune dysregulation can resurface, leading to the recurrence or worsening of sarcoidosis within scar tissue. This highlights the importance of careful monitoring and management of medication regimens in individuals with scar sarcoidosis to prevent flare-ups and ensure the disease remains under control.

Why is it important to recognize scar sarcoidosis early?

Early recognition of scar sarcoidosis is crucial because it presents unique diagnostic and therapeutic challenges. Its rarity and varied clinical presentation can lead to delayed diagnosis, potentially causing unnecessary suffering and complications for patients. Prompt identification allows for timely intervention, appropriate treatment strategies, and improved patient outcomes and quality of life. Raising awareness among healthcare professionals is key to ensuring that patients receive the care they need promptly and effectively.

If someone has orbital sarcoidosis, can it also appear in scar tissue, and why is this significant?

Yes, orbital sarcoidosis, which affects the eye area, can indeed recur in cutaneous scar tissue. This recurrence is significant because it complicates the diagnosis and management of the disease. The presence of scar sarcoidosis requires healthcare professionals to consider both the systemic nature of sarcoidosis and the specific characteristics of the affected scar tissue. This requires a comprehensive diagnostic workup and targeted treatment strategies to control the disease and prevent further complications. The case study mentions adalimumab, an immunosuppressant drug, and the effects of stopping the medication, which can trigger the recurrence.