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Scleredema of B uschke associated with difficult-to-control type 2 diabetes mellitus
Rev Assoc Med Bras 2016; 62(3):199-201 199
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Scleredema of Buschke associated with difficult-to-control type 2
diabetes mellitus
Luciana Rodino L emes1 *, Gabriele Medina Vilela1, Sandra Maria Barbosa Durães2, Enoi Aparecida Guedes Vilar3
1Graduate degree in Dermatology from Universidade Federal Fluminense (UFF), Niterói, RJ, Brazil
2PhD in Dermatology from Universidade Federal do Rio de Janeiro (UFRJ). Adjunct Professor IV, Dermatology, UFF, Niterói, RJ, Brazil
3MSc in Anatomical Pathology from UFF. Adjunct Professor, Pathology, UFF, Niterói, RJ, Brazil
Summary
Study conducted at Hospital
Universitário Antonio Pedro (HUAP),
Universidade Federal Fluminense (UFF),
Niterói, RJ, Brazil
Article received: 4/21/2015
Accepted for publication: 5/4/2015
*Correspondence:
Address: Rua Marquês de Paraná, 303,
Centro
Niterói, RJ – Brazil
Postal code: 24033-900
Scleredema of Buschke (SB) is a rare disorder of connective tissue characterized
by diffuse non-pitting induration of the skin, mainly on the cervical, deltoid and
dorsal regions. It is a cutaneous mucinosis of unknown etiology and is associ-
ated with bacterial or viral infections, hematological disorders and diabetes mel-
litus . Histopathological examination shows thickened dermis with wide colla-
gen bundles separated by gaps that correspond to mucopolysaccharide deposits,
visualized using special staining. Several treatments are reported in the litera-
ture without well-established results. We report a case of SB in a patient with
type 2 diabetes mellitus .
Keywords: scleredema adultorum, diabetes mellitus, dorsum.
Introduction
Scleredema of Buschke (SB) is a rare disorder of connective
tissue, perhaps more prevalent than reported in the litera-
ture, characterized by diffuse induration of the skin, espe-
cially in the cervical, deltoid and dorsal regions. Systemic
manifestations are also described.1 It is a cutaneous muci-
nosis divided into three types according to its associations.
Pathogenesis is unknown but triggering factors are described,
such as hyperinsulinemia, vascular damage, lymphatic ob-
struction, and streptococcal hypersensitivity. We report a
case of SB in a patient with type 2 diabetes mellitus.
Case
Male, 63-year old obese patient, with long-standing diffi-
cult-to-control diabetes mellitus, high blood pressure and
dyslipidemia; he presented erythema and induration of the
neck and upper back starting 1 month earlier (Figure 1).
The patient had no clinical history or laboratory findings
compatible with any infections or blood disorders. Histo-
pathological examination of the affected area on the back
showed: thickened collagen fibers in the reticular dermis
with gaps between them and mucin deposit confirmed by
staining with Alcian Blue at pH 2.5 (Figures 2 and 3).
Discussion
SB is a generally benign dermatosis, part of the group of
cutaneous mucinoses, with easy clinical and histopatho- FIGURE 1Erythema and induration of the neck and upper back.
logic diagnosis. SB was described by Buschke in 1902, and
classified into 3 subtypes by Graff, in 1968: Type 1, asso-
ciated with bacterial or viral infections; type 2, associat-
ed with paraproteinemias; and type 3, associated with di-
abetes mellitus.1,2
Type 1 SB has a rapid onset and is usually preceded
by fever. It is usually associated with infectious disease,
particularly streptococcal infections, including: tonsilli-
tis, pharyngitis, scarlet fever, cellulitis, otitis media, ne-
phritis, rheumatic fever, and erysipelas, but also other in-
fectious processes such as typhoid fever, impetigo,