Successful Novel Use of Low-Dose Sirolimus for Treatment-Refractory Cutaneous Sarcoidosis

We describe a 68-year-old woman with longstanding multisystem sarcoidosis and a 20-year history of cutaneous disease refractory to multiple immunomodulatory treatments, who experienced rapid symptomatic improvement and near-complete clearance of skin lesions within five months of starting adjunctive low-dose oral sirolimus 0.5 mg daily, without observed adverse effects. While this case adds to emerging observations of sirolimus’ potential effectiveness in refractory cutaneous sarcoidosis, the findings are exploratory, and further studies are warranted to establish the safety, efficacy, and appropriate role of low-dose sirolimus in the management of refractory cutaneous sarcoidosis.