Diabetic hand syndrome, also known as diabetic cheiroarthropathy, is a disorder marked by limited joint movement and features resembling scleroderma. Scleroderma-like skin changes are frequently linked to uncontrolled diabetes, in contrast to limited scleroderma, which typically manifests with a prior history of Raynaud’s phenomenon. This underscores the fact that scleroderma-like is often underdiagnosed and can mimic both autoimmune and microvascular disorders.

In this report, we presented a case of a 58-year-old diabetic female with a 1-year history of gradual stiffening of the fingers with frequent episodes of white-blue discoloration. Physical examination revealed multiple ulcers on sausage-shaped fingers, erythematous thick plaques topped with crust on the palms with associated induration, thickening, and a positive prayer sign. Biopsy of the palms and digits shows thickened collagen bundles in the superficial to deep dermis. Alcian blue was positive. Blood chemistry showed elevated glycosylated hemoglobin and fasting glucose. Immunoassays were negative for ANA, RF, anti-dsDNA, anti-RNP, anti-SM, anti-SSA, SCL70, and anti-CENP. Treatment with potent corticosteroid twice daily was started concurrently with the initiation of insulin by the endocrinologist.

Our case highlights the importance of early recognition of scleroderma-like cutaneous manifestations, whose close relationship to diabetes mellitus affects its overall morbidity. Prompt screening for endocrinopathy will help in early treatment initiation and prevent further complications.

Human ; Female ; Middle Aged: 45-64 Yrs Old ; Diabetes Mellitus

BACKGROUND

Efforts to control Hansen's d isease have progressed through multidrug therapy implementation. However, documented cases of relapse present challenges to its effective management and eradication. Understanding the contributing factors to relapse is crucial for optimizing treatment strategies and achieving better outcomes against Hansen's Disease.

OBJECTIVE

To determine the epidemiological profile and clinical patterns of patients diagnosed with Hansen's Disease Relapse in selected Tertiary Government Hospitals in the Philippines from November 2016 to October 2021.

METHODOLOGY

This was a multi-center, retrospective study involving a five-year chart review method. Charts of all Hansen's Disease Relapse patients were obtained from participating institutions with necessary approvals. Data collection followed approved forms, and patient profiles were analyzed using descriptive statistics. Pre- and post- relapse profiles were compared using T-tests, Wilcoxon tests, and Fisher's Exact Test. Relapse time across subgroups were assessed using Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

A total of 60 relapse cases were included in the study. Majority were single, unemployed males aged 26-35, with low household screening. The Bacillary Index significantly decreased post- relapse. Documented comorbidities included G6PD deficiency before treatment and lepra reactions during MDT. Patients on 12-month MDT regimens had higher relapse time than those on 24-month regimens.

CONCLUSION

This study underscores the influence of socioeconomic, gender, and age-related factors on relapse. It emphasizes the imperative for enhanced public health measures in accordance with the WHO Global Leprosy Strategy and the importance of considering clinical factors while advocating for continuous improvements in leprosy management protocols.

Human ; Multiple Chronic Conditions