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.

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

Foot Diseases ; etiology ; Humans ; Scleredema Adultorum ; Scleroderma, Systemic ; complications ; Skin

OBJECTIVE: To describe the clinical and ultrasonographic (US) findings in patients with scleredema adultorum of Buschke, who presented with sclerotic skin on their posterior neck. MATERIALS AND METHODS: After obtaining IRB approval, eight patients with scleredema adultorum of Buschke were enrolled. They underwent US examination of their posterior neck. The diagnoses were confirmed pathologically. The clinical history and US images were evaluated retrospectively. Dermal thickness was compared between the patient group and the age- and sex-matched control group. RESULTS: The patients included seven males and one female with a mean age of 51.5 years. All patients presented with thickening of the skin and/or a palpable mass on the posterior neck. Five (62.5%) of the eight patients showed erythematous discoloration. Six patients (75.0%) had a history of diabetes. The Hemoglobin A1c level was found to be increased in all patients. US images did not show any evidence of a soft tissue mass or infection. The mean dermal thickness in patients (7.01 ± 1.95 mm) was significantly greater than that in the control group (3.08 ± 0.87 mm) (p = 0.001). Multiple strong echogenic spots in the dermis were seen in all patients. Seven patients (87.5%) showed posterior shadowing in the lower dermis. CONCLUSION: When a patient with a history of diabetes presents with a palpable mass or erythematous discoloration of the posterior neck and US shows the following imaging features: 1) no evidence of a soft tissue mass or infection, 2) thickening of the dermis, 3) multiple strong echogenic spots and/or posterior shadowing in the dermis, scleredema adultorum of Buschke should be considered in the differential diagnosis.
Dermis ; Diagnosis ; Diagnosis, Differential ; Ethics Committees, Research ; Female ; Humans ; Male ; Neck* ; Retrospective Studies ; Scleredema Adultorum* ; Shadowing (Histology) ; Skin ; Ultrasonography

No abstract available.
Cyclosporine* ; Scleredema Adultorum*

No abstract available.
Scleredema Adultorum* ; Streptococcal Infections*

Scleredema is an uncommon condition of unknown etiology that is characterized by dermal mucinosis and mild sclerosis. It is a symmetrical, diffuse, non-pitting induration of the skin commonly associated with an antecedent febrile illness, diabetes mellitus or paraproteinemia.This is the case of an obese, middle-aged adult female with type 2 diabetes mellitus on oral hypoglycemic medication, who presented with an ill-defined, diffuse erythema and non-pitting induration of the skin on the posterior neck and upper back. It has been estimated that as many as 2.5%-14% of diabetic patients have scleredema. This subset of patients may be under-reported as a consequence of subtle onset and under- recognition. Even lithe prognosis of scleredemadiabeticorum is usually benign, it is important that this condition is recognized since it may have systemic involvement that can lead to complications.

Human ; Female ; Middle Aged ; Diabetes Mellitus, Type 2 ; Erythema ; Hypoglycemic Agents ; Obesity ; Paraproteinemias ; Prognosis ; Scleredema Adultorum ; Sclerosis ; Skin ; Diabetes Mellitus ; Mucinoses

Dermatomyositis (DM) is rare systemic inflammatory disease with typical skin manifestations and muscular involvement. Various skin lesions can accompany this disease, such as Gottron's sign, Heliotrope rash, mechanic's hands, V sign and shawl sign. Scleredema is a very rare skin manifestation in DM. We report a case of DM in a 63-year-old woman, who had scleredema on her thighs. A diagnosis of DM was established by clinical manifestation, elevated muscle enzyme levels, electromyogram measures, and muscle biopsy findings. She was successfully treated with the immunosuppressants methotrexate, cyclosporine, and steroids (low dose).
Biopsy ; Cyclosporine ; Dermatomyositis ; Exanthema ; Female ; Hand ; Humans ; Immunosuppressive Agents ; Methotrexate ; Middle Aged ; Muscles ; Scleredema Adultorum ; Skin ; Skin Manifestations ; Steroids ; Thigh

Scleroderma pathogenesis is the accumulation of extracellular matrix proteins and is a relatively rare connective tissue disorder characterized by skin fibrosis, obliterative vasculopathy, and distinct autoimmune abnormalities. However, many other clinical conditions known collectively as the scleroderma-like syndrome present with substantial skin fibrosis and may be confused with scleroderma, sometimes leading to an incorrect diagnosis. Due to this, early and correct diagnosis is very important to for appropriate treatment available for scleroderma-like syndrome. We report a rare case of scleredema mimicking systemic sclerosis with hypoalbuminemia induced by malabsorption in alcoholic chronic pancreatitis. In this case, the patient's skin sclerosis and joint contracture dramatically improved after high dose steroid theraphy.
Alcoholics ; Connective Tissue ; Contracture ; Extracellular Matrix Proteins ; Fibrosis ; Humans ; Hypoalbuminemia ; Joints ; Pancreatitis, Chronic ; Scleredema Adultorum ; Scleroderma, Systemic ; Sclerosis ; Skin

Scleredema and acanthosis nigricans are two distinct dermatological disorders that have been reported in association with insulin resistance. Few reported cases have shown an association between scleredema and acanthosis nigricans. A 53-year-old obese woman with diabetes mellitus presented with a 4-year history of an indurated plaque on the nape and upper mid-back. She also presented with a 20-year history of hyperpigmented, velvety plaques on the neck and both axillae. We report a diabetic patient who developed scleredema and acanthosis nigricans.
Acanthosis Nigricans ; Axilla ; Diabetes Mellitus ; Female ; Humans ; Insulin Resistance ; Middle Aged ; Neck ; Scleredema Adultorum

OBJECTIVETo investigate the clinical and pathologic characteristics of patients with scleredema.

METHODThe clinical and pathologic data of 67 outpatients with scleredema who were admitted to PUMC Hospital from 1982 to 2008 were retrospectively analyzed.

RESULTSNeck and upper back lesions were detected in all patients, but no hand or foot involvement was noted. Among 54 patients who received serum immunoglobulin examination, 19 (35.2%) showed abnormal serum immunoglobulin results. Among 67 patients, 22 (32.8%) had concomitant diabetes mellitus. Alcian blue staining was performed in 35 patients, among whom 23 (65.7%) had positive results and 12 (34.3%) had negative results.

CONCLUSIONSScleredema may have systemic involvements in addition to skin lesions. Patients with scleredema also tends to have concomitant diabetes mellitus. Alcian blue staining is not sufficient to differentiate scleredema and scleroderma.

Adolescent ; Adult ; Aged ; Child ; Child, Preschool ; Female ; Humans ; Immunoglobulins ; blood ; Male ; Neck ; pathology ; Retrospective Studies ; Scleredema Adultorum ; complications ; diagnosis ; pathology ; Skin ; pathology ; Young Adult