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ORIGINAL CONTRIBUTIONS |
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| Year : 2002 | Volume
: 56
| Issue : 6 | Page : 270-272 |
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Scleredema diabeticorum-a case report
MI Shaikh, P Kumar, Jeethan
Dept. of Skin & STD, K.M.C. Hospital, Attavar, Mangalore-575 001,
Correspondence Address:
M I Shaikh
Dept. of Skin & STD, K.M.C. Hospital, Attavar, Mangalore-575 001
PMID: 12649948
How to cite this article:
Shaikh M I, Kumar P, Jeethan. Scleredema diabeticorum-a case report. Indian J Med Sci 2002;56:270-2 |
Scleredema diabeticorum is a rare collagen disorder. It is characterised by diffuse, symmetrical skin thickening, a persistent erythema over the neck and back, and is associated with diabetes.
Case Report: A 41-year male presented with complaints of "taut" skin over neck and back with persistent redness of 1 year duration. The lesions showed symmetrical and gradual progression. The patient was diabetic since 12 years and was on regular treatment.
Examination of the patient showed blanching, non-tender, ill defined erythema with woody hard induration of skin over neck and upper back. The affected skin could not be pinched up [Figure - 1] and showed a "peau-de orange" appearance on pitting. [Figure - 2]. The erythema on the back blanched along the midline in a linear pattern on retraction of scapulae.
Investigations showed FBS - 176 mg/dl and PPES - 250 mg/dl/ Other investigations like ASO titer, Hepatitis A and C antibodies, urine for Bence Jones protein were negative.
Histopathology sections with Hematoxylin and Eosin stain [Figure - 3] showed a thickened dermis with swollen collagen bundles separated by clear fenestrations. The skin appendages were preserved. Special staining with Toluidine blue showed hyaluronic acid deposits in the spaces between the collagen fibers. These features were suggestive of scleredema.
| ¤ Discussion | |  |
Scleredema is a rare collagen disorder with deposition of hyaluronic acid in dermis. It has 2 forms: the classical postinfectious type (Sclaedema Adultorum of Bushke) and that associated with diabetes mellitus (Scleredema diabeticorum). The term Scleredema diutinum refers to the same condition and was coined by McNaughten[1]. Its association with Diabetes Mellitus and Multiple Myeloma is known[2].
Scleredema adultorum occurs in children and young adults with a male preponderance. There is history of prior infection like a sore throat. The clinical features are preceded by fever, sudden in onset and localised to the neck and back. Spontaneous resolution occurs in 75% of cases in 2 years[3]. In a group of patients studied it was found that Scleredema developed following scarlet fever, measles, influenza and other diseases of streptococcal origin[4].
Scleredema diabeticorum occurs in middle-aged individuals with a female preponderance. It is associated with insulin resistant diabetes of long standing duration. The clinical features are insidious in onset and show extensive involvement of the body, The lesions persist indefinitely. Scleredema has to be differentiated from Scleroderma and Scleromyxedema[2] Scleroderma shows features like Raynauds phenomena, skin atrophy, involvement of hands and feet and its histopathology is distinct.
Scleromyxedema shows popular lesions having predilection for the hands, forearms, trunk, face and neck.
The treatment of scleredema is unsatisfactory although various methods like intralesional injections, hyaluronidase and triamcinolone have been tried.
| ¤ Summary | | |
A 41 year male, diabetic on treatment presented with persistent erythema and. "taut" skin over neck and back since 1 year. The lesions showed symmetric and gradual progression. There was no history of prior sore throat. On examination effected skin was erythematous, woody hard and unpinchable. Scleredema diabeticorum (diutinum), although sharing clinical and historical features with Scleredema adultorum has no prodromal infection, is more extensive and affected individuals are characteristically obese, middle aged diabetics who often have accompanying microangiopathies and macro angiopathies.
Recognition of scleredema by the physician has prognostic and therapeutic implications in the management of the coexisting diabetes.
| ¤ References | | |
| 1. | Menaughten F., Keczkes F. Scleredema adultorum and Diabetes Mellitus (Scleredema diutinum) Clin Exp. De, matolosy 1983; 8:41; 45.  |
| 2. | Venece PY, Powell FC, Daniel SU. Scleroderma - A Review of 34 cases - J Am Acad Dermatol 1984; 11: 128-134. |
| 3. | JE Jelinek, Collagen Disorder's in which Diabetes and Cutaneous Features Coexist. In: The Skin In Diabetes pp 155-173, Publishers Lei and Febiger, 1986. |
| 4. | Thomas G, Fernandez R, Dhurandhar MW, Fernandez JC. Scleredema (a case report and review of lierature) Ind J Dermatol Venereal Leprol 1975; 41: 66-69. |
Figures
[Figure - 1], [Figure - 2], [Figure - 3]
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