Severe scleredema diabeticorum and insulin resistance.

Scleredema, an unusual disorder of the skin, is associated with symmetric induration and thickening of the skin generally on the posterior neck and the upper back.1-4 Scleredema is classified. into two types, scleredema adultorum of Buschke and scleredema diabeticorum.4,5 Scleredema adultorum of Buschke is more commonly diagnosed in children, despite the term adultorum, and is 'usually preceded by an acute infection, often streptococcal. Clinically, this type can easily be recognized by observing the patient's indurated, nonpitting skin. Although there have been cases in which internal organs are involved by scleredema, the disease usually enters remission without any treatment within 18 months. Scleredema diabeticorum is generally associated with non-insulin-dependent diabetes mellitus (NIDDM).1,6,7 While this second type of scleredema involves the upper back and neck in a manner similar to the Buschke type, scleredema diabeticorum can involve a more extensive region of the body, extremities, and internal organs. Scleredema diabeticorum can persist for many years, and there is no effective therapy. Histologically, the dermis is characterized by hyperplasia of collagen and increased accumulation of gIycosaminoglycans and hyaluronic acid in both types of scleredema.