Background Scleredema adultorum of Buschke is a rare disorder characterized by non-pitting hardening of the skin around the neck, shoulders, occasionally the face and the trunk. The most frequent form of scleredema is associated with diabetes mellitus (DM). The histopathologic features of scleredema are characterized by thickened collagen bundles within the reticular dermis that are separated by mucopolysaccharides (mainly mucin) containing fenestrations.
Objectives To compare clinical data of patients with Buschke-scleredema-DM to diabetic patients without skin involvement patients (Control-DM) with a focus on the late vascular and neurological complications.
Methods Clinical data of 105 diabetic patients were investigated based on their medical histories and physical examinations. All subjects met the following inclusion criteria: each of their disease duration time of DM had to be more than three years. Twenty-eight patients with Scleredema-DM were collected (three of type 1 and 25 of type 2 diabetes, 19 female, nine male; their mean age (±SD) was 63.0±9.3 and mean DM-duration time was 17.9±9.6 years). Seventy-seven consecutive, age and DM-duration matched patients without skin involvement were investigated as controls (nine patients with type 1 and 68 with type 2 M, 50 female, 27 male, their mean age was 63.3±11.9 and mean DM-duration time was 17.4±10.7 years). For statistical analysis Pearson's Chi-squared, Fisher and Mann-Whitney U tests were used.
Results In the medical history of the Scleredema-DM group stroke occurred more frequently (8 of 28 cases, 28.6%) compared to the Control-DM group (5/77, 6.5%, /p<0.01/). There were no significant differences in the occurrence of myocardial infarction (5/28, 17.9% vs. 10/77 cases, 13.0%), nephropathy (5/28, 17.9% vs. 10/77 cases, 13.0%), retinopathy (13/28 cases 46.4% vs. 28/77, 36.3%) and of peripheral neuropathy (21/28 patients, 75.0% vs. 49/77, 63.6%) respectively. Higher level of cholesterol and triglycerides was present in the Scleredema-DM group compared to the Control-DM cases (mean cholesterol was: 5.7±1.5 mmol/l vs. 4.6±1.2 mmol/l, /p<0.01/; triglyceride: 2.3±1.1 mmol/l vs. 1.84±1.6 mmol/l /p<0.01/), though there were no significant differences in the mean actual level of hemoglobin A1c in the sera, or comparing the body mass index (BMI) between the two investigated groups.
Cholesterol levels were significantly higher in both Scleredema-DM patients group taking /p<0.01/ or not taking /p<0.05/ statins compared to similar control diabetic patient groups. Concerning the triglyceride, also a higher levels of triglyceride were found in Scleredema-DM patients who were taking statins /p<0.05/, compared Control-DM patients who were also taking statins, but no difference were shown in triglyceride levels between the Scleredema-DM group and the Control-DM group both who were not treated by statins.
Conclusions Scleredema can be assessed by a simple skin-examination and might be a risk factor for stroke in patients with DM. Patients with scleredema are associated with increased cholesterol and triglyceride levels and a higher incidence of stroke compared to matched DM control population.
Disclosure of Interest None declared
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