Advertisement

Clinical, radiological, and histological characteristics of Chinese type 2 diabetic patients with diabetic scleredema: an observational study

  • Yingying Zhou
  • Chaoming Wu
  • Zhijuan Dai
  • Jian Jin
  • Yaoxin Zhu
  • Yanying QianEmail author
Original Article
  • 14 Downloads

Abstract

Objectives

Diabetic scleredema (DS) is reported rarely in China and its features are poorly documented. We aim to describe the characteristics of Chinese patients with DS clinically, radiologically, and histologically.

Methods

Of 9825 hospitalized participants with diabetes older than 18 years, 15 type 2 diabetes patients with DS as well as 15 non-DS patients with type 2 diabetes were included in this observational study.

Results

All the individuals with DS presented diffuse erythema, non-pitting, and painless indurations on the skin of the nape and upper back. Patients with DS were mainly middle-aged or elderly (male to female ratio, 4:1), with long-standing poorly controlled type 2 diabetes, overweight, or obese. Patients with DS vs non-DS had a higher prevalence of diabetic microvascular complications, neuropathy, hypertension, cerebral infarction, nicotine abuse, and alcohol abuse. LDL-C level was significantly higher in the DS group (p = 0.0143), and the skin and subcutaneous fat in T2-weighted MRI were significantly thickened in the DS group than in the non-DS group (p < 0.01). Skin biopsies showed thickened collagen bundles throughout the dermis and active fibroblast proliferation.

Conclusion

Our reports suggest that DS is relatively rare in Chinese patients with diabetes. DS occurs both in middle-aged and elderly patients (male predominantly), overweight or obese, having long-term poorly controlled type 2 diabetes, and presenting a high incidence of microvascular complications, hypertension, neuropathy, and ischemic cerebral stroke. High LDL-C level, nicotine abuse, and alcohol abuse may be risk factors. MRI could be preferable to assess the severity of DS non-invasively.

Keywords

Diabetic scleredema Type 2 diabetes Thickened collagen bundles Low-density lipoprotein cholesterol Magnetic resonance imaging 

Notes

Acknowledgements

The corresponding author had full access to all data in the study and had final responsibility for the decision to submit for publication. We thank all the patients for their cooperation.

Author contributions

Y.Y.Z. analyzed the data and drafted the manuscript. Z.J.D., J.J., and C.M.W. conceived and designed the study and revised the article. C.M.W., Y.X.Z., and Y.Y.Z. conducted the literature review and interpretation of the study results. Y.Y.Q. edited the final manuscript.

Funding information

This research was supported by Zhejiang Provincial Natural Science Foundation of China (no. LY15H070003) and Wenzhou Municipal Science and Technology Bureau (no. Y20170253).

Compliance with ethical standards

Conflict of interest

None of the authors have any conflicts of interest to declare.

Human and animal rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

References

  1. 1.
    Murphy-Chutorian B, Han G, Cohen SR. Dermatologic manifestations of diabetes mellitus: a review. Endocrinol Metab Clin N Am. 2013;42:869–98.CrossRefGoogle Scholar
  2. 2.
    Levy L, Zeichner JA. Dermatologic manifestation of diabetes. J Diabetes. 2012;4:68–76.CrossRefGoogle Scholar
  3. 3.
    Cole GW, Headley J, Skowsky R. Scleredema diabeticorum: a common and distinct cutaneous manifestation of diabetes mellitus. Diabetes Care. 1983;6:189–92.CrossRefGoogle Scholar
  4. 4.
    Martin C, Requena L, Manrique K, Manzarbeitia FD, Rovira A. Scleredema diabeticorum in a patient with type 2 diabetes mellitus. Case Rep Endocrinol. 2011;2011:560273.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Chatterjee S. Neck pain, stiffness, and periorbital edema in a man with diabetes. Jama. 2016;315:1159–60.CrossRefGoogle Scholar
  6. 6.
    Miyares FJ, Kuriakose R, Deleu DT, El-Wahad NA, Al-Hail H. Scleredema diabeticorum with unusual presentation and fatal outcome. Indian J Dermatol. 2008;53:217–9.CrossRefGoogle Scholar
  7. 7.
    Wilson BE, Newmark JJ. Severe scleredema diabeticorum and insulin resistance. J Am Board Fam Pract. 1995;8:55–7.PubMedGoogle Scholar
  8. 8.
    Yang W, Lu J, Weng J, Jia W, Ji L, Xiao J, et al. Prevalence of diabetes among men and women in China. N Engl J Med. 2010;362:1090–101.CrossRefGoogle Scholar
  9. 9.
    Krakowski A, Covo J, Berlin C. Diabetic scleredema. Dermatologica. 1973;146:193–8.CrossRefGoogle Scholar
  10. 10.
    Kobayashi T, Yamasaki Y, Watanabe T. Diabetic scleredema: a case report and biochemical analysis for glycosaminoglycans. J Dermatol. 1997;24:100–3.CrossRefGoogle Scholar
  11. 11.
    Nakajima K, Iwagaki M, Ikeda M, Kodama H. Two cases of diabetic scleredema that responded to PUVA therapy. J Dermatol. 2006;33:820–2.CrossRefGoogle Scholar
  12. 12.
    Koga N. Beneficial effect of aggressive low-density lipoprotein apheresis in a familial hypercholesterolemic patient with severe diabetic scleredema. Ther Apher. 2001;5:506–12.CrossRefGoogle Scholar
  13. 13.
    Koga N. Effects of low-density lipoprotein apheresis on coronary and carotid atherosclerosis and diabetic scleredema in patients with severe hypercholesterolemia. Ther Apher. 2001;5:244–51.CrossRefGoogle Scholar
  14. 14.
    Brownlee M, Cerami A, Vlassara H. Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications. N Engl J Med. 1988;318:1315–21.CrossRefGoogle Scholar
  15. 15.
    Rongioletti F, Kaiser F, Cinotti E, Metze D, Battistella M, Calzavara-Pinton PG, et al. Scleredema. A multicentre study of characteristics, comorbidities, course and therapy in 44 patients. J Eur Acad Dermatol Venereol. 2015;29:2399–404.CrossRefGoogle Scholar
  16. 16.
    Sternberg M, Urios P, Grigorova-Borsos AM. Effects of glycation process on the macromolecular structure of the glomerular basement membranes and on the glomerular functions in aging and diabetes mellitus. C R Seances Soc Biol Fil. 1995;189:967–85.PubMedGoogle Scholar
  17. 17.
    Chvapil M, Hurych J. Control of collagen biosynthesis. Int Rev Connect Tissue Res. 1968;4:67–196.CrossRefGoogle Scholar
  18. 18.
    Ikeda Y, Suehiro T, Abe T, Yoshida T, Shinoki T, Tahara K, et al. Severe diabetic scleredema with extension to the extremities and effective treatment using prostaglandin E1. Intern Med. 1998;37:861–4.CrossRefGoogle Scholar
  19. 19.
    Mattheou-Vakali G, Ioannides D, Thomas T, Lazaridou E, Tsogas P, Minas A. Cyclosporine in scleredema. J Am Acad Dermatol. 1996;35:990–1.CrossRefGoogle Scholar
  20. 20.
    Dogramaci AC, Inan MU, Atik E, Gokce C. Scleredema diabeticorum partially treated with low-dose methotrexate: a report of five cases. Balkan Med J. 2012;29:218–21.CrossRefGoogle Scholar
  21. 21.
    Breuckmann F, Appelhans C, Harati A, Rotterdam S, Altmeyer P, Kreuter A. Failure of low-dose methotrexate in the treatment of scleredema diabeticorum in seven cases. Dermatology. 2005;211:299–301.CrossRefGoogle Scholar
  22. 22.
    Matsuura K, Umebayashi Y, Otsuka F. Computed tomography reveals thickened subcutaneous tissue in scleroedema. Br J Dermatol. 1997;137:1015–6.CrossRefGoogle Scholar
  23. 23.
    Cole GW, Handler SJ, Burnett K. The ultrasonic evaluation of skin thickness in scleredema. J Clin Ultrasound. 1981;9:501–3.CrossRefGoogle Scholar
  24. 24.
    Blaicher W, Prayer D, Bernaschek G. Magnetic resonance imaging and ultrasound in the assessment of the fetal central nervous system. J Perinat Med. 2003;31:459–68.CrossRefGoogle Scholar
  25. 25.
    Kokpol C, Rajatanavin N, Rattanakemakorn P. Successful treatment of scleredema diabeticorum by combining local PUVA and colchicine: a case report. Case Rep Dermatol. 2012;4:265–8.CrossRefGoogle Scholar
  26. 26.
    Thumpimukvatana N, Wongpraparut C, Lim HW. Scleredema diabeticorum successfully treated with ultraviolet A1 phototherapy. J Dermatol. 2010;37:1036–9.CrossRefGoogle Scholar
  27. 27.
    Alsaeedi SH, Lee P. Treatment of scleredema diabeticorum with tamoxifen. J Rheumatol. 2010;37:2636–7.CrossRefGoogle Scholar

Copyright information

© Research Society for Study of Diabetes in India 2018

Authors and Affiliations

  • Yingying Zhou
    • 1
  • Chaoming Wu
    • 1
  • Zhijuan Dai
    • 1
  • Jian Jin
    • 1
  • Yaoxin Zhu
    • 1
  • Yanying Qian
    • 1
    Email author
  1. 1.Department of EndocrinologyThe Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical UniversityZhejiangChina

Personalised recommendations