Clinical case report for family physicians


Clinical case report:

A 50 years old gentleman complains of progressive skin thickening over his neck and upper back in the past 6 months. He is a known case of non-insulin dependent diabetes. He denies any recent infection or change of medications. Physical examination reveals indurations over the nape of neck and upper back with the ‘peau d’orange’ appearance. The skin temperature is not increased and the range of neck movement is full. Blood tests including CBP, renal and liver function test and thyroid function test are normal.

Scleredema, also known as Scleredema of Buschke, is a rare, self-limiting, skin condition defined by progressive thickening and hardening of the skin, usually on upper back, neck, shoulders and face. The skin may also change color to red or orange. The cause of scleredema is unknown, it is usually associated with a disease, most of the times being diabetes, a viral illness or strep throat.

Skin biopsy (hematoxylin and eosin stained) shows a thick reticular dermis with thick collagen bundles separated by clear spaces.

Although many types of medications have been tried as treatments, none of them have been proven effective in treating scleredema. Those treatments, such as corticosteroids, may benefit the patient, but it will not cure their condition. The symptoms of the condition usually resolve within 6 months to 2 years after onset. However, patients whose condition was associated to diabetes may suffer for longer periods of time.