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Clinical analysis of 60 cases of scleredema is reported with emphasis on clinical manifestations, microcirculatory changes, histopathological and ultrastructural observations. It is noted that the prognosis of scleredema may not always be good, and severe cases may lose their working capacity or even die. Attention should be paid to proper treatment of scleredema and long term follow-up is indicated to observe its course, outcome and pattern of evolution.

The association of specific dermatological complications with diabetes mellitus is well recognized. Of 100 hospital-based patients with diabetes mellitus (age 48 years +/- 2SE), 14% had scleroedema diabeticorum. The affected subjects had a higher prevalence of retinopathy (p less than 0.001) and albuminuria (p less than 0.025). The duration of scleroedema correlated with the duration of diabetes (p less than 0.005). These findings highlight the relatively common occurrence of this skin condition which often goes unrecognized in people with diabetes.

Many skin lesions are specific for diabetes mellitus. Necrobiosis lipoidica, lipoatrophy and idiopathic bullae (bullosis diabeticorum) are usually associated with diabetes. However, diabetic scleredema has not been noticed by internists, although dermatologists have paid attention to such a cutaneous manifestation. We reported a clinical case of a female diabetic patient aged 15 who had been afflicted with diabetic scleredema. She had been treated with insulin since 5 years of age. She noticed stiffness of the skin in April 1980. Skin biopsy showed thickness of the dermis and accumulation of acid mucopolysaccharide. After control of blood glucose with continuous subcutaneous insulin infusion (CSII) and administration of tocopherol acetate and hyaluronidase, the skin lesion improved. Etiology of diabetic scleredema is unknown. Such skin lesion which is observed frequently in insulin dependent obese patients is different from a category of scleredema of Buschke.

A 48-year-old male developed an induration of the skin of the neck a few days after a blunt trauma to this region had occurred. A diagnosis of scleredema adultorum (Buschke) could be established 3 years later. In view of the history and the lack of other diseases thought to be related to the elicitation of scleredema, a traumatic origin of the skin condition is probable.