Scleroderma‐like lesions in insulin‐dependent diabetes mellitus

Abstract

We report on two patients (one female 42 years, one male 47 years) suffering from insulin-dependent diabetes mellitus (IDDM) for more than 20 years. Both patients exhibited sclerodactyly and sclerosis of the hands and lower arms as well as swelling and slight contracture of the distal interphalangeal joints. Interestingly, internal organs were not involved and autoantibodies characteristic for scleroderma were missing. Poor utilization and excess of glucose seem to be responsible for the activation of fibroblasts to produce abundant matrix proteins in the skin. Significant therapeutic improvement of the glucose metabolism was able to improve joint contractures or at least to stop the progression of skin changes in our patients. These skin changes should not be misdiagnosed as systemic sclerosis.

An Unusual Form of Generalized Granuloma Annulare in a Patient Insulin-dependent Diabetes Mellitus

“…Poor glucose utilization may be responsible for the stimulation of ® broblasts to produce abundant amounts of matrix proteins deposited in the skin. In addition, an increased nonenzymatic glycosylation of dermal collagen, with an associated decrease in collagen degradation, may contribute to scleroderma-like syndrome (16). Our patient had a full-blown picture of scleroderma-like syndrome with irreversible contractures and waxy thickening and sclerosis of the overlying skin.…”

Escleredema Diabeticorum

“…Su causa es desconocida; sin embargo, se encuentra relación con una larga evolución de la enfermedad, obesidad mórbida, y tratamiento con altas dosis de insulina. También se asocia a mal control glucémico y presencia de acantosis nigricans (3,4). Se han podido plantear hipótesis relacionadas con su etiopatogenia con estados hiperglucémicos prolongados que conllevan a la formación irreversible de complejos glicosilados de colágeno y la alteración en la actividad enzimática de las colagenasas dan como resultado acumulación excesiva de colágeno y mucina en la dermis reticular (4).…”

Dermatologic manifestation of diabetes

“…Scleredema diabeticorum, characterized by asymptomatic, indurated plaques on the upper back, neck and shoulders, occurs in approximately 2.5%–14% of diabetics, with the highest prevalence seen in obese, type 2 diabetic men 44,45 . It is thought that elevated glucose levels stimulate collagen production from fibroblasts and may interfere with collagen degradation 46 …”