Distribution of Sclerotic Lesions in Scleredema Diabeticorum
Sclerotic lesions in scleredema diabeticorum characteristically involve the upper back, posterior neck, and shoulders, with a distinctive distribution pattern that spares the hands and feet. 1, 2
Primary Distribution Pattern
The hallmark distribution involves:
- Upper back and posterior neck - These are the most consistently affected areas, representing the classic presentation 1, 2
- Shoulders and upper trunk - Extension from the neck and upper back commonly occurs 3
- Face - Can be involved in some cases, occasionally presenting with leonine facies due to skin thickening 1
Key Distinguishing Features
The distribution notably spares the distal extremities - unlike systemic sclerosis, scleredema diabeticorum does not typically affect the hands, fingers, or feet 4. This is a critical distinguishing feature when differentiating from other sclerosing conditions.
Extent of Involvement
- Localized pattern - Most cases remain confined to the upper body (neck, upper back, shoulders) 2
- Extensive "cuirasse" pattern - In severe cases, the sclerotic changes can extend across the entire trunk in a breastplate-like distribution, which may be associated with restrictive lung disease due to chest wall involvement 3
Clinical Implications
The upper back and neck distribution leads to:
- Skin tightness and stiffness in affected areas 2
- Decreased range of motion, particularly of the neck 2
- Pain and stiffness localized to the posterior neck region 2
- When extensive trunk involvement occurs, respiratory function may be compromised and should be assessed 3
Important caveat: While the classic distribution is upper back and neck, clinicians should recognize that extensive cases can involve broader trunk areas, and rare presentations may include facial involvement 1, 3.