By Gary M. White, MD
Sclerederma diabeticorum (SD) is the firm, non-pitting edema of the upper back, often in the shape of an inverted triangle, in a middle-aged, obese, long-standing diabetic. The posterior neck may also be affected.
- A study of 100 hospital-based patients with diabetes mellitus found an incidence of 14% [Diabetic Medicine 1988;5;465] and its occurrence correlated with the duration of diabetes.
- A case of diffuse sclerederma has been reported in association with a malignant insulinoma, suggesting the possibility that it is the elevated insulin which may cause the skin changes.
- See also Limited Joint Mobility Syndrome for a similar condition with induration of the skin in a diabetic.
- See also differential diagnosis for the mucinoses in scleromyxedema.
No treatment is necessary. Better control of the diabetes is always recommended, but is not clear to have an effect. Cream PUVA resulted in marked improvement in one patient. Methotrexate 15 mg subcutaneously over 3 months improved the condition in 5 patients [Balkan Med J. 2012 Jun; 29(2): 218–221]. The cream used (0.001% 8-MOP in a water-in-oil emulsion) was applied one hour before light exposure, and the entire process was performed 4 times per week.
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