Endocrine Abstracts

Introduction: Scleredema is a rare skin disease, clinically presents as diffuse, painless induration, and thickening of skin. It primarily affects the upper part of body and usually occurs in association with diabetes mellitus, infections or monoclonal gammopathy. We discussed a case of scleredema in patient with history of diabetes mellitus.

Case report: A 54-year-old woman with history of long-standing, poorly-controlled diabetes mellitus, hypertension, and coronary artery disease was referred to our department. She complained to gradually-developing several months, and hardening erythematous plaques on the neck and upper back. Her medication included metformin (2000 mg/day) and premixed insulin (50 U/day). Physical examination revealed edematous, erythematous plaques on posterior neck and upper back. Other systemic evaluations were normal. Complete blood count and comprehensive biochemical panel were normal, exception of fasting blood glucose of 277 mg/dl. HbA1c was 11.8%. The patient was examined by dermatologist and skin biopsy was performed. On histopathological examination; epidermis was normal but there is prominent separation of collagen fibres throughout the dermis, thickening of the dermis and coarsening of collagen. Focal alcian blue positive mucine was also detected. Histopathological findings were consistent with scleredema. She had shown no infection signs. Scleredema was thought to be secondary to diabetes. She was started on intensive insulin regimen and glucose levels decreased within normal range. She was started on local PUVA therapy. After 2 months; redness and oedema of skin has partially disappeared, mobility of the back improved and skin of upper back was softer.

Conclusion: Scleredema diabeticorum is a rare complication of diabetes and reveals in obese subjects with long standing and poorly controlled diabetes mellitus. It can be clinically and histopathologically differentiated by other fibrosing disorders. Tight glycaemic control is recommended but efficiency has not been proven. Ultraviolet A-1 phototherapy and PUVA seem to be most effective treatments for this disease.