Abstract
Although scleredema is a rare connective tissue disease characterized by symmetric thickening and/or induration of the skin of the back of the neck and upper back, we found seven cases of scleredema among 63 non-insulin dependent diabetic inpatients. Two male and five female patients, ranging from 37 to 63 years of age, had diabetes mellitus of 3 to 20 years duration. More than half of them were poorly controlled and had long-standing obesity, retinopathy, proteinuria, neuropathy and cardiovascular abnormalities. Two patients had elevated immunoglobulin levels, one because of IgA, the other because of IgG and IgM, without evidence of multiple myeloma. Histological examination on skin biopsy specimens taken from three patients revealed marked thickening of the dermis with thick and swollen collagen bundles. Colloidal iron-stained sections disclosed dense deposits of acid mucopolysaccharides between the collagen bundles, predominantly in the lower dermis. In conclusion, (1) the incidence of scleredema detected as a result of careful physical examination was quite high in diabetic patients, (2) a tendency toward severe diabetic complications and frequent association with monoclonal gammopathy should be emphasized in patients with diabetic scleredema.
