From the Research
The primary skin manifestation of scleredema in diabetes mellitus (DM) is a diffuse, non-pitting swelling and induration of the skin, characterized by the accumulation of mucopolysaccharides in the dermis. Diabetic scleredema (DM scleredema) is a rare connective tissue disease with a poorly understood pathogenesis, and it is strictly associated with Diabetes mellitus [ 1 ]. This condition leads to thickening and hardening of the skin, most commonly affecting the upper back, neck, and shoulders. The skin histology is characterized by a normal or slightly thinned epidermis, and the dermis containing a decreased number of elastic fibers and thick large swollen collagen bundles separated by mucopolysaccharide deposits in the deep reticular dermis [ 1 ].
Some key features of DM scleredema include:
- Accumulation of mucopolysaccharides (glycosaminoglycans) in the dermis [ 1 ]
- Thickening and hardening of the skin [ 1 ]
- Decreased motility of the shoulders and impairment of respiratory function [ 2 ]
- Association with long-standing, poorly controlled diabetes mellitus [ 1 ]
Management of DM scleredema primarily involves improving glycemic control in diabetic patients [ 1 ]. There is no specific treatment for the skin changes, but addressing the underlying diabetes can help prevent progression and potentially lead to some improvement over time [ 1 ]. Other treatments, such as topical steroid cream and UVA-1 phototherapy, may also be effective in some cases [ 1, 3 ].
It is essential to note that the evidence is based on the most recent and highest quality study available, which is [ 1 ] from 2022. This study provides the most up-to-date information on the primary skin manifestation of scleredema in diabetes mellitus.