Question

I have a sarcoid in my nose. What is the best treatment for this? I have constant nasal infections and seem to have a cold or some type of sinus drainage all the time.

Answer

You are unfortunate in that upper respiratory tract sarcoidosis of the nose, nasopharyngeal (nasal passages) mucosa and larynx (voice box) is uncommon. When it occurs, it causes obstruction, crusting, discharge and epistaxis (bleeding from the nose). As no treatable pathogenic factor has yet been discovered, the present therapy is non-specific and governed by the control of symptoms. Most aspects can be ameliorated by anti-inflammatory drugs.

The conventional treatment is a large dose of steroids to produce suppression of symptoms and the disease process, and then a maintenance dose which is often between 5 and 10 mg prednisolone (prednisone) per day. Whilst there seems to be no doubt that corticosteroids such as prednisone improve local and constitutional symptoms and suppress granulomatous inflammation, there is no general agreement on the benefit of long-term steroid treatment.

Non-steroidal anti-inflammatory drugs such as aspirin or indomethacin may help control symptoms and spare the use of steroids. Other drugs that have been used are the anti-malarial drug chloroquine, and cytotoxic or immunosuppressive drugs in low doses, which may well prove to be steroid-sparing. You would clearly require the advice of your doctor before embarking on any of these treatment regimes.