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Scleredema diabeticorum

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

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.

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 scleredema, contact 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

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, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM. Mucinoses. In: James WD, Elston DM, Treat JR, Rosenbach MA, Neuhaus IM, eds. Andrews' Diseases of the Skin: Clinical Dermatology. 13th ed. Philadelphia, PA: Elsevier; 2020:chap 9.

Patterson JW. Cutaneous mucinoses. In: Patterson JW, ed. Weedon's Skin Pathology. 5th ed. Philadelphia, PA: Elsevier Limited; 2021:chap 14.

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

Simms RW. Localized scleroderma and scleroderma-like syndromes. In: Hochberg MC, Gravallese EM, Silman AJ, Smolen JS, Weinblatt ME, Weisman MH, eds. Rheumatology. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 155.

  • Diabetes

    Animation

  •  

    Diabetes - Animation

    Diabetes is on the rise worldwide, and is a serious, lifelong disease that can lead to heart disease, stroke, and lasting nerve, eye and foot problems. Let's talk about diabetes and the difference between the three types of diabetes. So, what exactly is diabetes and where does it come from? An organ in your body called the pancreas produces insulin, a hormone that controls the levels of your blood sugar. When you have too little insulin in your body, or when insulin doesn't work right in your body, you can have diabetes, the condition where you have abnormally high glucose or sugar levels in your blood. Normally when you eat food, glucose enters your bloodstream. Glucose is your body's source of fuel. Your pancreas makes insulin to move glucose from your bloodstream into muscle, fat, and liver cells, where your body turns it into energy. People with diabetes have too much blood sugar because their body cannot move glucose into fat, liver, and muscle cells to be changed into and stored for energy. There are three major types of diabetes. Type 1 diabetes happens when the body makes little or no insulin. It usually is diagnosed in children, teens, or young adults. But about 80% of people with diabetes have what's called Type 2 diabetes. This disease often occurs in middle adulthood, but young adults, teens, and now even children are now being diagnosed with it linked to high obesity rates. In Type 2 diabetes, your fat, liver, and muscle cells do not respond to insulin appropriately. Another type of diabetes is called gestational diabetes. It's when high blood sugar develops during pregnancy in a woman who had not had diabetes beforehand. Gestational diabetes usually goes away after the baby is born. But, still pay attention. These women are at a higher risk of type 2 diabetes over the next 5 years without a change in lifestyle. If you doctor suspects you have diabetes, you will probably have a hemoglobin A1c test. This is an average of your blood sugar levels over 3 months. You have pre-diabetes if your A1c is 5.7% to 6.4%. Anything at 6.5% or higher indicates you have diabetes. Type 2 diabetes is a wake up call to focus on diet and exercise to try to control your blood sugar and prevent problems. If you do not control your blood sugar, you could develop eye problems, have problems with sores and infections in your feet, have high blood pressure and cholesterol problems, and have kidney, heart, and problems with other essential organs. People with Type 1 diabetes need to take insulin every day, usually injected under the skin using a needle. Some people may be able to use a pump that delivers insulin to their body all the time. People with Type 2 diabetes may be able to manage their blood sugar through diet and exercise. But if not, they will need to take one or more drugs to lower their blood sugar levels. The good news is, people with any type of diabetes, who maintain good control over their blood sugar, cholesterol, and blood pressure, have a lower risk of kidney disease, eye disease, nervous system problems, heart attack, and stroke, and can live, a long and healthy life.

  • Diabetes

    Animation

  •  

    Diabetes - Animation

    Diabetes is on the rise worldwide, and is a serious, lifelong disease that can lead to heart disease, stroke, and lasting nerve, eye and foot problems. Let's talk about diabetes and the difference between the three types of diabetes. So, what exactly is diabetes and where does it come from? An organ in your body called the pancreas produces insulin, a hormone that controls the levels of your blood sugar. When you have too little insulin in your body, or when insulin doesn't work right in your body, you can have diabetes, the condition where you have abnormally high glucose or sugar levels in your blood. Normally when you eat food, glucose enters your bloodstream. Glucose is your body's source of fuel. Your pancreas makes insulin to move glucose from your bloodstream into muscle, fat, and liver cells, where your body turns it into energy. People with diabetes have too much blood sugar because their body cannot move glucose into fat, liver, and muscle cells to be changed into and stored for energy. There are three major types of diabetes. Type 1 diabetes happens when the body makes little or no insulin. It usually is diagnosed in children, teens, or young adults. But about 80% of people with diabetes have what's called Type 2 diabetes. This disease often occurs in middle adulthood, but young adults, teens, and now even children are now being diagnosed with it linked to high obesity rates. In Type 2 diabetes, your fat, liver, and muscle cells do not respond to insulin appropriately. Another type of diabetes is called gestational diabetes. It's when high blood sugar develops during pregnancy in a woman who had not had diabetes beforehand. Gestational diabetes usually goes away after the baby is born. But, still pay attention. These women are at a higher risk of type 2 diabetes over the next 5 years without a change in lifestyle. If you doctor suspects you have diabetes, you will probably have a hemoglobin A1c test. This is an average of your blood sugar levels over 3 months. You have pre-diabetes if your A1c is 5.7% to 6.4%. Anything at 6.5% or higher indicates you have diabetes. Type 2 diabetes is a wake up call to focus on diet and exercise to try to control your blood sugar and prevent problems. If you do not control your blood sugar, you could develop eye problems, have problems with sores and infections in your feet, have high blood pressure and cholesterol problems, and have kidney, heart, and problems with other essential organs. People with Type 1 diabetes need to take insulin every day, usually injected under the skin using a needle. Some people may be able to use a pump that delivers insulin to their body all the time. People with Type 2 diabetes may be able to manage their blood sugar through diet and exercise. But if not, they will need to take one or more drugs to lower their blood sugar levels. The good news is, people with any type of diabetes, who maintain good control over their blood sugar, cholesterol, and blood pressure, have a lower risk of kidney disease, eye disease, nervous system problems, heart attack, and stroke, and can live, a long and healthy life.

     

    Review Date: 6/19/2021

    Reviewed By: Ramin Fathi, MD, FAAD, Director, Phoenix Surgical Dermatology Group, Phoenix, AZ. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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