Sirolimus in Cutaneous Sarcoidosis

Inclusion criteria

• Age ≥ 18 years old <75 years old (men and women)
• Cutaneous sarcoidosis of the face (diagnosed according to the following criteria : compatible clinical appearance showing erythemato-purple, brownish or yellowish macules or papules or nodules and compatible histological appearance with a facial or extra facial skin biopsy confirming the diagnosis of sarcoidosis showing epithelioid and giganto-cellular granuloma without caseous necrosis) moderate to severe defined by: "Facial SASI" Score (Sarcoidosis Area and Severity Index) ≥ 2 and PGA (Physician's Global Assessment,0 to 10 scale) ≥ 5
• Health insurance plan coverage
• Patients who never had a systemic treatment or who had at least one classical systemic treatment failure for sarcoidosis treatment
• For women of childbearing age (unless post-menopausal or sterile), pregnancy test with βHCG negative. Effective contraception should be used during sirolimus treatment and for 12 weeks after stopping sirolimus
• Patients who have signed a written consent

Exclusion criteria

• Severe hepatic failure (Cytolysis (ALAT)> 3N and / or Cholestase (PAL)> 3N)
• Allergy or intolerance to sirolimus or at one of its excipients
• Allergy to peanut or soybeans
• Patient with a pulmonary or hepatic graft
• General corticotherapy or immunosuppressive treatment (methotrexate, azathioprine, mycophenolate mofetil, cyclophosphamide, ciclosporin) in the month before the inclusion
• Intra-lesional corticotherapy for less than 3 months
• Biotherapy (anti-TNFa, anti-IL12/23, anti-IL17A) within 3 months preceding the inclusion
• Thalidomide or other -imide treatment for less than 3 months
• Cyclins treatment for less than 1 month
• Topical corticosteroids or topical tacrolimus for less than 1 week
• Sarcoidosis involvement of at least one organ requiring systemic treatment other than sirolimus (oral corticosteroid or systemic immunosuppressive treatment)
• Cholesterolemia> 300 mg/ dl or triglyceridemia> 400 mg/dl
• Administration of strong CYP3A4 inhibitors or inducers such as rifampicin, ketoconazole, voriconazole, telithromycin , diltiazem, verapamil, erythromycin, clarythromycin, ciclosporin
• Pregnancy or breastfeeding
• Active infection including tuberculosis disease
• Non-controlled arterial hypertension (TAS> 150 mmHg and / or TAD> 100 mmHg)
• Patient under guardianship or curatorship, patients deprived of freedom, under safeguarding of justice, receiving psychiatric care, under the constraint, admitted in a health or social institution for purposes other than those of research
• Patient with cancer (except cutaneous basal cell carcinoma or in situ cervical cancer)
• Risk of patient bad compliance
• Grapefruit or grapefruit juice consumption during the treatment duration
• Patients with fructose intolerance, galactose intolerance, glucose-galactose malabsorption, insufficiency in sucrase-isomaltase or Lapp lactase