Scleredema diabeticorum

Definition

Scleredema diabeticorum is a skin condition that occurs in some people with diabetes. It causes skin to become thick and hard on the back of the neck, shoulders, arms, and upper back.

Alternative Names

Scleredema of Buschke; Scleredema adultorum; Diabetic thick skin; Scleredema; Diabetes - scleredema; Diabetic - scleredema; Diabetic dermopathy

Causes

Scleredema diabeticorum is thought to be a rare disorder, but some people think that the diagnosis is often missed. The exact cause is unknown. The condition tends to occur in men with poorly-controlled diabetes who:

• Are obese
• Use insulin
• Have poor blood sugar control
• Have other diabetes complications

Symptoms

Skin changes happen slowly. Over time, you may notice:

• Thick, hard skin that feels smooth. You cannot pinch the skin over the upper back or neck.
• Reddish, painless lesions.
• Lesions occur on the same areas on both sides of the body (symmetrical).

In severe cases, thickened skin can make it hard to move the upper body. It also can make deep breathing difficult.

Some people find it hard to make a clenched fist because the skin on the back of the hand is too tight.

Exams and Tests

Your provider will perform a physical exam. You will be asked about your medical history and symptoms.

Tests may include:

• Fasting blood sugar
• Glucose tolerance test
• A1C test
• Skin biopsy

Treatment

There is no specific treatment for scleredema. Treatments may include:

• Improved control of blood sugar (this may not improve the lesions once they have developed)
• Phototherapy, a procedure in which the skin is carefully exposed to ultraviolet light
• Glucocorticoid medications (topical or oral)
• Electron beam therapy (a type of radiation therapy)
  
• Medicines that suppress the immune system
• Physical therapy, if you find it hard to move your torso or breathe deeply
  
  

Outlook (Prognosis)

The condition cannot be cured. Treatment may improve movement and breathing.

When to Contact a Medical Professional

Contact your provider if you:

• Have trouble controlling your blood sugar
• Notice symptoms of scleredema

If you have the scleredema, call your provider if you:

• Find it hard to move your arms, shoulders, and torso, or hands
• Have trouble breathing deeply due to tight skin

Prevention

Keeping blood sugar levels within range helps prevent diabetes complications. However, scleredema can occur, even when blood sugar is well controlled.

Your provider may discuss adding medicines that allow insulin to work better in your body so that your insulin doses can be reduced.

References

Ahn CS, Yosipovitch G, Huang WW. Diabetes and the skin. In: Callen JP, Jorizzo JL, Zone JJ, Piette WW, Rosenbach MA, Vleugels RA, eds. Dermatological Signs of Systemic Disease. 5th ed. Philadelphia, PA: Elsevier; 2017:chap 24.

Flischel AE, Helms SE, Brodell RT. Scleredema. In: Lebwohl MG, Heymann WR, Berth-Jones J, Coulson IH, eds. Treatment of Skin Disease: Comprehensive Therapeutic Strategies. 5th ed. Philadelphia, PA: Elsevier; 2018:chap 224.

James WD, Berger TG, Elston DM. Mucinoses. In: James WD, Berger TG, Elston DM, eds.  Andrews' Diseases of the Skin. 12th ed. Philadelphia, PA: Elsevier; 2016:chap 9.

Patterson JW. Cutaneous mucinoses. In: Patterson JW, ed. Weedon's Skin Pathology. 4th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2016:chap 13.

Rongioletti F. Mucinoses. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 46.