Scleredema Diabeticorum is a rare fibromucinous connective tissue disease, with only 27 cases reported in the Philippines. This condition is linked to diabetes mellitus, characterized by skin thickening and induration, particularly on the neck and upper back. This condition results from excessive collagen deposition and is often seen in patients with poorly controlled blood glucose levels. Timely identification and intervention are crucial for enhancing patient outcomes.

This is a case of a 46-year-old Filipino woman, initially treated as a case of psoriasis vulgaris, with a 3-year history of skin thickening and induration on the upper back and nape with progressive limited range of motion. These findings were not elicited upon initial consultation, only to be unveiled later, adding complexity to her condition. Further investigation revealed an elevated HbA1C of 10.7%. Histopathology showed thickened collagen bundles, leading to a diagnosis of scleredema diabeticorum. She underwent UVA1 phototherapy, with a total of 40 sessions, twice a week with the maximum dose of 90 J/cm2 and oral Methotrexate with a dose of 10mg/week. The patient showed significant improvement in induration and range of motion. Patient was referred to Internal Medicine for co-management.

In conclusion, this case highlights the complexity of diagnosing scleredema diabeticorum in a patient initially treated for psoriasis vulgaris. The discovery of skin induration and elevated HbA1C emphasizes the need for thorough re-evaluation in chronic conditions. The patient’s positive response to UVA1 phototherapy and methotrexate demonstrates its effectiveness, reinforcing the importance of continuous evaluation in complex dermatological cases.