Martín C, Requena L, Manrique K, Manzarbeitia F D, Rovira A
Endocrinology and Nutrition Department, Fundación Jiménez Díaz-Capio, 28040 Madrid, Spain.
Case Rep Endocrinol. 2011;2011:560273. doi: 10.1155/2011/560273. Epub 2011 Jul 31.
Background. Scleredema adultorum, a connective tissue disorder of unknown aetiology, is characterized by a thickening of the reticular dermis in the upper back of the body that may decrease the mobility of the affected tissues. It has been reported in diabetic patients with poor metabolic control. Therapeutic options are limited with generally poor results. Case Report. 53-year-old white male with type 2 diabetes mellitus was referred to our department for evaluation of incipient nephropathy and retinopathy. On examination, he presented erythematous, indurated, painless and ill-defined plaque on the skin of the upper back with limited movement of shoulders. A biopsy was done revealing scleredema. PUVA treatment and physiotherapy were started with the amelioration of mobility and acquiring some elasticity of the upper back. Discussion. The development of scleredema in diabetic patients has been related to prolonged exposure to chronic hyperglycaemia. Our patient has had diabetes for 20 years with an acceptable glucose control, however he developed the scleredema 10 years ago. Conclusions. Scleredema is a rare connective disorder that seems to appear most frequently in diabetic subjects. Good metabolic control seems not to preclude its development. PUVA treatment and physiotherapy are therapeutic options that seem to be of some help.
背景。成人硬肿病是一种病因不明的结缔组织疾病，其特征是身体上背部网状真皮增厚，这可能会降低受影响组织的活动能力。在代谢控制不佳的糖尿病患者中已有报道。治疗选择有限，总体效果不佳。病例报告。一名53岁的2型糖尿病白人男性因早期肾病和视网膜病变被转诊至我科。检查时，他上背部皮肤出现红斑、硬结、无痛且边界不清的斑块，肩部活动受限。活检显示为硬肿病。开始进行光化学疗法（PUVA）和物理治疗后，上背部的活动能力有所改善，并获得了一定弹性。讨论。糖尿病患者硬肿病的发生与长期暴露于慢性高血糖有关。我们的患者患有糖尿病20年，血糖控制尚可，但他在10年前患上了硬肿病。结论。硬肿病是一种罕见的结缔组织疾病，似乎最常出现在糖尿病患者中。良好的代谢控制似乎不能阻止其发生。光化学疗法（PUVA）和物理治疗是似乎有一定帮助的治疗选择。
