Medical Pearl: Scleroderma-like skin changes in patients with diabetes mellitus

Yosipovitch, Gil; Loh, Keh‐Chuan; Hock, Ong Beng

doi:10.1067/mjd.2003.254

Cited by 27 publications

(15 citation statements)

References 21 publications

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“…6 Scleroderma-like skin changes of the hand have also been described in patients with diabetes mellitus. 7,8 However, these changes are usually bilateral, painless and Raynaud's phenomenon is not observed.…”

Section: Discussionmentioning

confidence: 97%

Unilateral limited scleroderma‐like changes following formation of an arteriovenous fistula

Roberts

Curnow

2007

Aust J Dermatology

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A 55-year-old man presented with a 1-year history of progressive skin thickening involving the right hand associated with Raynaud's phenomenon, sclerodactyly and painful cutaneous ulcers. An arteriovenous fistula for haemodialysis had been formed on the same arm 2 years previously. There were no symptoms or signs of systemic sclerosis or involvement of the contralateral arm. The limb was clinically ischaemic, attributed to a vascular steal phenomenon from the arteriovenous fistula, superimposed on occlusive arterial disease. A revascularization procedure was performed, which resulted in substantial improvement in the sclerodactyly, Raynaud's phenomenon and hand function. Tissue hypoxia is believed to be a contributing factor in the pathogenesis of scleroderma, and this case demonstrates scleroderma-like changes in the setting of limb ischaemia.

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Section: Discussionmentioning

confidence: 97%

Unilateral limited scleroderma‐like changes following formation of an arteriovenous fistula

Roberts

Curnow

2007

Aust J Dermatology

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“…Strikingly, the histopathological picture of diabetes-induced musculoskeletal findings, in particular, those concerning the hands, is very similar to scleroderma [4]. Microscopic examination of diabetes-induced hand findings indicates thick dermis, an increment in cross-linked collagen in the reticular dermis, and small amounts of mucin [5]. Similarly in scleroderma, there is thickening of the dermis and excessive production of fibrillar collagen along with changes in the architecture of connective tissue components [6].…”

Section: Discussionmentioning

confidence: 99%

Diabetic Sclerodactyly Mimicking Limited Sclerosis: Case Report and Review of the Literature

Afzal¹,

Movahedian²,

Singh³

et al. 2017

J Endocrinol Metab

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Diabetes mellitus can be associated with a variety of musculoskeletal conditions. These conditions mostly occur in longstanding and poorly controlled diabetes and are the result of progressive alterations in tissues. Timely recognition of these conditions is of paramount clinical importance as diabetes control helps in preventing progressive deformity and disability, pain control, and maintaining reasonable quality of life. In addition, some of these conditions can be addressed with available treatment modalities. We present a 43-year-old female with a longstanding history of type 1 diabetes mellitus admitted for diabetic ketoacidosis. She had a significant prior history of musculoskeletal conditions. Physical examination findings of her hands revealed thick and tight skin, sclerodactyly, and "prayer sign". Appropriate workup to rule out systemic and limited sclerosis was performed and was negative.

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“…Adults with non-insulindependent diabetes mellitus may also show sclerodermalike skin thickening [52,53], and fibrous breast lumps may also appear [54]. Skin changes [55] are usually seen in patients with long-standing, severe, complicated, maturity onset diabetes mellitus [20]. Increased nonenzymatic glycosylation of collagen may have a collagen stabilizing effect contributing to the skin sclerosis.…”

Section: Disorders With Metabolic Abnormalitiesmentioning

confidence: 97%

Clinical Features of Scleroderma-Like Disorders: A Challenge for the Rheumatologist

Czirják¹,

Varjú

2006

CRR

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Systemic sclerosis (SSc) is characterized by vascular abnormalities, fibrosis, inflammatory changes, and late stage atrophy/obliterative vasculopathy. Localized scleroderma forms show a longitudinal or circumscribed skin involvement. In scleroderma-like disorders the distribution/characteristics of skin involvement seem to be "atypical" as compared to classic SSc, and the acral skin involvement is usually missing. Exposure to certain chemicals or drugs may also suggest the presence of a scleroderma-like disease. Lack of Raynaud's phenomenon, scleroderma-specific antinuclear antibodies, scleroderma capillary pattern on nailfold capillaroscopy, and typical internal organ manifestations may also indicate the presence of a scleroderma-like disorder. For differential diagnosis skin biopsy is almost always required.Scleroderma-like disorders include diseases with mucin deposition (scleromyxedema, scleredema, etc.). Some disorders show papular-nodular skin changes with or without dermal deposition of materials (amyloid, mucin deposition; fibroblastic rheumatism, etc.). Diseases with monoclonal gammopathy (scleromyxedema, POEMS syndrome, myeloma with scleroderma-like skin changes) also belong to the large group of scleroderma-like diseases. Some disorders are characterized by eosinophilia (diffuse fasciitis with eosinophilia, eosinophilia-myalgia syndrome, toxic oil syndrome), metabolic/biochemical abnormalities (IDDM, nephrogenic fibrosing dermopathy), and endocrine abnormalities (POEMS syndrome, hypo/hyperthyroidism with mucin deposition, diabetes). Chronic graft-versus host disease (cGVHD) may also show scleroderma-like skin changes.Scleroderma-like disorders can be induced by drugs or chemicals (eosinophilia-myalgia syndrome, toxic oil syndrome, vinyl-chloride disease; cytostatic/appetite suppressant, etc), and also by physical injury (trauma, vibration stress, radiation injury). Inherited progeroid syndromes with early ageing (Werner's syndrome, etc.), and a large heterogeneous group of hereditary disorders with either skin thickening (porphyria, phenylketonuria) or skin atrophy/tightening (restrictive dermopathy, scleroatrophic and keratotic dermatosis of the limbs, etc.) should also be taken in consideration in the differential diagnosis of scleroderma-like disorders. These categories are not mutually exclusive, because the remarkably different scleroderma-like diseases show overlapping features.

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Medical Pearl: Scleroderma-like skin changes in patients with diabetes mellitus

Cited by 27 publications

References 21 publications

Unilateral limited scleroderma‐like changes following formation of an arteriovenous fistula

Unilateral limited scleroderma‐like changes following formation of an arteriovenous fistula

Diabetic Sclerodactyly Mimicking Limited Sclerosis: Case Report and Review of the Literature

Clinical Features of Scleroderma-Like Disorders: A Challenge for the Rheumatologist

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