Clinical, radiological, and histological characteristics of Chinese type 2 diabetic patients with diabetic scleredema: an observational study
- 14 Downloads
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.
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.
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.
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.
KeywordsDiabetic scleredema Type 2 diabetes Thickened collagen bundles Low-density lipoprotein cholesterol Magnetic resonance imaging
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.
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.
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.