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HomeHealth articlesscleredema diabeticorumWhat Are the Causes of Scleredema Diabeticorum?

Scleredema Diabeticorum - Causes, Symptoms, Diagnosis, Treatment, and Prevention

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Scleredema Diabeticorum is a skin problem commonly occurring in people with diabetes. Read more about scleredema diabeticorum below.

Written by

Dr. K. Shobana

Medically reviewed by

Dr. Sandhya Narayanan Kutty

Published At September 6, 2022
Reviewed AtJune 5, 2024

What Is Scleredema?

Scleredema is a form of cutaneous mucinosis with an unknown cause. Cutaneous mucinosis includes a diverse group of skin conditions caused by the accumulation of mucin, a jelly-like complex carbohydrate substance present on the skin. The common signs and symptoms are hardening and tightening of the skin and restricting movements. In addition, the skin on the affected region appears red or brown with an orange appearance.

What Are the Types of Scleredema?

There are three types of scleredema. All three types can restrict movement, but serious consequences are rarely shown in some cases. Occasionally, swallowing and speech are affected. Other organs, such as the eyes, tongue, parotid gland, muscles, joints, and heart, can also be affected.

Type 1 Scleredema:

Type one is an acute type of scleredema. It originates from a Streptococcus pyogenes infection. Hardening on the skin of the face and neck develops quickly and spreads to the upper trunk and arms. This condition spontaneously resolves within six months to two years and commonly affects middle-aged women and children.

Type 2 Scleredema:

Type 2 scleredema is not associated with infection. Instead, it develops more slowly and persists without showing any predominant symptoms.

Type 3 Scleredema:

Type 3 scleredema, or scleredema diabeticorum, often develops in diabetic patients. The skin on the neck, shoulder, arms, and upper back thickens slowly over months or years. Alternative names for scleredema diabeticorum are scleredema of buschke, scleredema adultorum, and diabetic scleredema.

What Is the Difference Between Scleredema and Scleroderma?

Scleroderma is a group of rare diseases that causes abnormal connective tissue growth, resulting in patches of tight skin. It also results from the overproduction and accumulation of collagen in the body's tissues. In most cases, scleroderma occurs due to genetics, environmental triggers, and immune system problems. There are different types of scleroderma, which often affect females. Signs and symptoms of scleroderma vary according to the type of scleroderma. In some cases, scleroderma affects only the skin. In other cases, it can also cause damage to internal structures such as blood vessels and other internal organs. Doctors diagnose scleroderma by the patient’s medical history, physical examination, laboratory tests, and skin biopsy. Though there is no cure, various treatments help to control symptoms and complications.

Scleredema presents as ill-defined, woody, and non-pitting plaques on the skin. The affected skin appears red or brown with an orange skin appearance. The face may appear expressionless, and the mouth may have difficulty opening. The rapidity of onset and locations of involvement differ based on the type of scleredema. It is often diagnosed by skin biopsy, and treatment varies according to the type of scleredema.

Though scleredema and scleroderma look similar, they differ in their histologic appearance. The scleredema is differentiated from scleroderma by the presence of mucin without skin adnexa destruction.

What Are the Causes of Scleredema Diabeticorum?

The exact cause behind scleredema diabeticorum is unknown. However this condition often tends to occur more commonly in males with uncontrolled diabetes, obesity, people using insulin, and other people facing diabetic complications.

Other types of scleredema can develop in people experiencing,

1) Febrile illness with streptococcus infection.

2) Trauma.

3) Multiple myeloma.

4) Drug reaction.

Scleredema also develops in people with other systemic diseases, such as,

1) Diabetes mellitus.

2) Hyperparathyroidism.

3) Sjogren syndrome.

4) Rheumatoid arthritis.

5) Malignant insulinoma.

6) HIV (human immunodeficiency virus) infection.

What Are the Symptoms of Scleredema Diabeticorum?

The symptoms develop slowly. Over time, the affected person may notice,

  1. Thick, hard skin that remains smooth.

  2. Reddish, painless lesions occur on the same site on both sides of the body.

In severe cases, thickened skin can cause difficulty moving the upper body and breathing problems. Some people may face problems making a clenched fist because the skin on the back of the hand may remain tight.

How to Diagnose Scleredema Diabeticorum?

A person may consult a doctor when they have difficulty controlling their blood sugar and noticeany symptoms of scleredema. The doctor might perform a physical examination and ask about the patient's medical history and other symptoms.

No imaging tests are required to diagnose scleredema. The other diagnostic tests advised are fasting blood sugar, glucose intolerance, A1C (glycated hemoglobin), and skin biopsy. Skin biopsy shows mucin deposits between collagen bundles in the dermis. In some cases, imaging tests are required when scleredema occurs and is associated with internal malignancies.

How Is Scleredema Diabeticorum Treated?

There is no specific treatment for this condition. The treatments that may help are,

1) Consistent control of blood sugar.

2) Phototherapy, a procedure where the skin is exposed carefully to ultraviolet light.

3) Taking Glucocorticoid medications, either orally or topically.

4) Electron beam therapy (a type of radiation therapy).

5) Medicines that suppress the immune system.

6) Physical therapy is when a person faces trouble moving their torso or breathing deeply.

What Are the Complications Faced Due to Scleredema?

The complications faced are a limited range of motion, poor wound healing, recurrent skin infections, dysarthria, dysphagia, difficulty closing the eyes, and restrictive lung disease.

What Is the Prognosis of This Condition?

This condition is incurable, and treatment may improve breathing and movement.

Though scleredema is a benign condition limited to the skin, it can cause limitations in movement. Reduced joint mobility, difficulty opening the mouth and eyes, or restrictive lung disease occur in extensive trunk involvement. Scleredema on the tongue can cause dysarthria, difficulty in masticating, and tongue protrusion. The pharynx, esophagus, and skeletal and cardiac muscle may also be affected.

Scleredema can cause:

1) Cardiomyopathy.

2) Heart failure.

3) Arrhythmias.

4) Pericardial effusion.

5) Unexplained murmurs in the cardiac muscle.

How to Prevent the Development of Scleredema Diabeticorum?

Keeping blood sugar levels within range prevents the development of diabetic complications. However, scleredema may also occur when blood sugar levels remain well controlled. The doctor can prescribe medications that reduce insulin doses to improve insulin's effectiveness in the body.

What Is the Outlook of This Condition?

This condition cannot be cured, but treatment can help breathing and movement.

When to Consult a Doctor?

The person should consult the doctor if

  • They have trouble controlling their blood pressure.

  • If they notice any symptoms of scleroderma.

  • If the person finds it hard to move their arms, shoulders, hands, or torso.

  • Find it difficult to breathe due to tight skin.

Conclusion:

Scleredema diabeticorum is a skin problem commonly found in people with diabetes. In uncontrolled diabetes, scleredema diabeticorum causes thickened skin and difficulty moving and breathing. So, diabetic patients have to take their medications appropriately, and keeping their blood sugar under control through exercise and diet reduces the risk of developing scleredema diabeticorum.

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Dr. Sandhya Narayanan Kutty
Dr. Sandhya Narayanan Kutty

Venereology

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