Lupus Pernio (Sarcoidosis)

A 48-year-old African-American woman presents with a 2-year history of slowly enlarging violaceous-red, indurated plaques on the nose, cheeks, and earlobes. Diascopy reveals an "apple-jelly" yellow-brown infiltrate. She reports chronic nasal congestion and hoarseness. Chest imaging shows bilateral hilar lymphadenopathy and restrictive lung disease (FVC 62%). Serum ACE level is elevated at 78 U/L. Skin biopsy reveals non-caseating epithelioid cell granulomas in the dermis with sparse lymphocytic infiltration. AFB and fungal stains are negative; cultures are sterile. The lesions marked **B** in the diagram are consistent with which diagnosis, and what is the most appropriate systemic treatment for this condition?