Cutaneous lesions of sarcoidosis present with various manifestations including 
specific and non-specific cutaneous lesions. Ichthyosiform sarcoidosis is a rare 
form of cutaneous sarcoidosis, presenting with asymptomatic, adherent, polygonal 
scales, mainly appearing on the lower limbs.  Ichthyosiform sarcoidosis has a 
predilection for dark-skinned races, and cases affecting Japanese patients have 
rarely been reported in English literature.  We herein describe three Japanese 
cases of ichthyosiform sarcoidosis on the lower limbs. All of the patients were 
female, with an age range of 57-69 years old.  Histologically, sarcoidal 
granulomas were located in the mid- to lower dermis.  All cases had scar 
sarcoidosis on the knees.  Furthermore, Case 1 presented with papular 
sarcoidosis on the back, and Case 3 presented with subcutaneous nodules on the 
buttock as well as erythema nodosum-like lesions on the lower legs.  All 
patients had lung sarcoidosis, but ocular sarcoidosis was seen in only Case 2. 
Case 3 showed Heerfordt syndrome with facial nerve paralysis. Histological 
features showed that the granular layers were scarcely detected in the overlying 
epidermis; however, filaggrin expression was not decreased.  Sarcoidal 
granulomas accumulated around the sweat glands in one case, whereas those 
features were not detected in the other two cases. In conclusion, ichthyosiform 
cutaneous sarcoidosis may be overlooked or misdiagnosed as xerotic dry skin 
which is frequently found in elderly people, and ichthyosiform cutaneous lesions 
may be more prevalent than previously estimated.