Screening for the presence of scleroedema adultorum of Buschke in patients with diabetes mellitus: newly diagnosed patients had a high prevalence of dyslipidaemia

Viktória Csonka, Beáta Bódis, Dániel Kovács, Nelli Farkas, Endre Kálmán, László Czirják, Cecília Varjú, Viktória Csonka, Beáta Bódis, Dániel Kovács, Nelli Farkas, Endre Kálmán, László Czirják, Cecília Varjú

Abstract

Background: Scleroedema adultorum of Buschke is a rare disorder characterized by fibromucinous thickening of the dermis that manifests mainly at the nape of the neck and on the upper back and shoulders. This study screened patients with diabetes mellitus for skin hardening caused by scleroedema adultorum of Buschke and characterized the clinical and laboratory findings in patients with newly identified cases, with a focus on lipid metabolism abnormalities and vascular complications.

Methods: Out of 113 consecutive patients with diabetes, 11 (9.7%) new scleroedema patients, all with type 2 diabetes, were found. Their clinical and laboratory data were compared to those of the rest of the screened patients and to those of a cohort of 15 patients with scleroedema and diabetes who were already being treated in a tertiary clinical centre at the University of Pécs.

Results: Higher proportions of patients with dyslipidaemia, hypertriglyceridemia (P < 0.05) and increased mean levels of non-high-density lipoprotein cholesterol (non-HDL-C) were found (P < 0.01) in both scleroedema groups than in the group without scleroedema. Stroke and venous thromboembolism (VTE) were more frequently found in the histories of both the newly identified scleroedema group (each 3/11; 27.3%) and the treated cohort (each 6/15; 40.0%) than in the group without scleroedema (6/102; 5.9% in cases of stroke P = 0.021, P < 0.001; and 14/102; 13.7%; P < 0.05 in cases of VTE, respectively). Based on binary logistic regression, a high non-HDL-C level (odds ratio (OD): 3.338, confidence interval (CI): 1.77-6.28; P < 0.001) and insulin treatment (OR 7.64, CI 1.9-29.3; P = 0.003) were independent predictors of scleroedema in patients with diabetes mellitus.

Conclusions: Diabetes patients with scleroedema had more severe dyslipidaemia and higher occurrence of vascular complications compared to those without scleroedema. In addition to poorly controlled type 2 diabetes mellitus requiring insulin treatment, high non-HDL-C levels may be another contributing factor to the development of scleroedema.

Trial registration: NCT04335396 .

Keywords: Diabetes mellitus; Dyslipidaemia; Fibromucinous thickening; Non-alcoholic fatty liver disease (NAFLD); Scleroderma-like; Scleroedema.

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Scleroedema adultorum of Buschke in a patient with diabetes mellitus
Fig. 2
Fig. 2
a Haematoxylin-eosin staining (5x). Skin sample from the upper part of the back. Deep dermis. The collagen bundles are coarse and separated by apparently empty spaces. Note the overview in the insert in the upper corner. b Hale’s colloidal iron staining (5x). Back skin. Deep dermis. The same area as the H&E staining. Between the coarse collagen fibres, the accumulated mucopolysaccharides appear blue. Note the overview in the insert in the upper corner
Fig. 3
Fig. 3
Complications in patients with diabetes mellitus, comparison of patients with and without the presence of scleroedema adultorum of Buschke. *P < 0.05 Scleroedema patients versus diabetes patients without scleroedema. ** Mean follow-up time of the treated patients was 5.5 ± 1.9 years
Fig. 4
Fig. 4
Comparison of serum lipid parameters of patients with diabetes mellitus (DM) with scleroedema (statin users n = 18/ non users n = 8) and and without scleroedema skin disorders (statin users n = 44/ non users n = 56). P-values were calculated with Mann-Whitney U test; non-HDL-cholesterol: serum non-high-density lipoprotein cholesterol level

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