From the Research
Scleredema in diabetes mellitus is characterized by thickening of the skin, which is the most accurate description among the given options. The characteristic skin change in scleredema (diabetic scleredema) associated with Diabetes Mellitus (DM) is primarily marked by dermal thickening, which leads to hardened skin. This condition is often associated with long-standing, poorly controlled diabetes, particularly type 2 diabetes 1, 2. The skin becomes firm, waxy, and bound to underlying tissues, typically affecting the upper back, neck, and shoulders, and can lead to restricted mobility in these areas.
The pathophysiology involves excessive deposition of collagen and mucopolysaccharides in the dermis, resulting from chronic hyperglycemia that promotes abnormal cross-linking of collagen fibers and impairs collagen degradation 3, 4. While accumulation of mucopolysaccharides is indeed a part of the pathophysiological process, the primary and most direct characteristic skin change is the thickening of the skin itself.
Key points about scleredema in diabetes mellitus include:
- It is more common in patients with poorly controlled, long-standing diabetes, particularly type 2.
- The condition affects approximately 2.5-14% of diabetic patients.
- Unlike other forms of scleredema, the diabetic variant tends to be persistent and less likely to resolve spontaneously, making glycemic control an essential part of management 5, 4.
- The clinical presentation can include decreased motility of the shoulders and impairment of respiratory function due to the skin changes.
Given the options provided, thickening of the skin (A) is the most accurate description of the characteristic skin change in scleredema associated with diabetes mellitus.