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Skin-nontumor / Clinical Dermatology

Other dermatoses

Scleredema of Buschke

Reviewer: Mowafak Hamodat, MB.CH.B, MSc., FRCPC, Eastern Health, St. Johns, Canada (see Reviewers page)
Revised: 2 August 2011, last major update August 2011
Copyright: (c) 2002-2011, PathologyOutlines.com, Inc.

Definition
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● Nonpitting, woody induration of upper back skin; associated with diabetes
● Rare primary mucinosis that presents with non pitting indurated edema and associated dermal hardening in the absence of any clinical abnormality
● After viral infection, especially UTI or insidious onset with no prior acute illness
● Occasionally associated with paraproteinemia, secondary hyperparathyroidism, rheumatoid arthritis, Sjogren’s syndrome, HIV infection and nuchal fibroma

Case reports
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● 72 year old man with diabetes associated disease (Dermatol Online J 2003;9:11)

Clinical description
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● Symmetrical non pitting edema and dermal hardening, which affects the posterior and lateral aspect of the neck, face, upper trunk and upper limbs
● Rarely affects lower abdomen and legs

Micro description
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● Epidermis appear slightly thinned or normal
● Thickened reticular dermis, often at expense of subcutaneous fat; eccrine glands in upper third of mid dermis
● Collagen fibers are broadened, abnormally separated by clear spaces, which may contain mucin
● May be mild chronic inflammatory cell infiltrate in superficial dermis, increased mast cells, but normal amount of fibroblasts

Micro images
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Left-H&E; right-colloidal iron

Negative stains
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● Negative direct immunofluorescence

Differential diagnosis
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● Scleroderma: appendages are atrophic or absent; diffuse dermal sclerosis, not the fenestrated appearance of scleredema

Additional references
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● eMedicine

End of Skin-nontumor / Clinical Dermatology > Other dermatoses > Scleredema of Buschke

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