Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.


Alexander Kreuter, MD
Section Editor
Jeffrey Callen, MD, FACP, FAAD
Deputy Editor
Abena O Ofori, MD


Scleredema (synonym: scleredema adultorum of Buschke) is a sclerotic skin disease that usually occurs in association with diabetes mellitus, infection (particularly streptococcal infection of the upper respiratory tract), or monoclonal gammopathy. Scleredema is characterized by the development of diffuse, woody induration of the skin and primarily affects the upper body (picture 1A-C).

The clinical course of scleredema varies from spontaneous resolution within several months, which often occurs in scleredema that follows a streptococcal upper respiratory infection, to persistent disease. Data on the treatment options for scleredema are primarily limited to case reports; therefore, the best approach to treatment remains unclear.

The clinical features, diagnosis, and management of scleredema will be discussed here. Other sclerotic disorders of the skin, such as systemic sclerosis (scleroderma) and scleromyxedema are distinct from scleredema. Overviews of these disorders are provided separately. (See "Overview of the clinical manifestations of systemic sclerosis (scleroderma) in adults" and "Scleromyxedema".)


The German dermatologist Abraham Buschke (1868–1943) has been credited with the first description of scleredema [1]. However, it seems that the original report can be traced to a description by Pitford in 1876.

The exact prevalence of scleredema is not known. Although scleredema is generally considered a rare disorder, the possibility that scleredema is underrecognized is suggested by a prospective study of 484 patients with diabetes in California that found a prevalence of scleredema of 2.5 percent [2]. A smaller Kuwaiti study found an even higher prevalence of scleredema in diabetic patients; among 100 patients with diabetes, scleredema was diagnosed in 14 percent [3].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Nov 15, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Buschke A. Ueber Skleroedem. Berl Klin Wochenschr 1902; 39:955.
  2. Cole GW, Headley J, Skowsky R. Scleredema diabeticorum: a common and distinct cutaneous manifestation of diabetes mellitus. Diabetes Care 1983; 6:189.
  3. Sattar MA, Diab S, Sugathan TN, et al. Scleroedema diabeticorum: a minor but often unrecognized complication of diabetes mellitus. Diabet Med 1988; 5:465.
  4. Boin F, Hummers LK. Scleroderma-like fibrosing disorders. Rheum Dis Clin North Am 2008; 34:199.
  5. Isaac A, Costa I, Leal I. Scleredema of Buschke in a child with cardiac involvement. Pediatr Dermatol 2010; 27:315.
  6. Nagi A, Memon IA. Scleredema of Buschke in pediatric age group. J Coll Physicians Surg Pak 2005; 15:311.
  7. Rongioletti F, Kaiser F, Cinotti E, et al. Scleredema. A multicentre study of characteristics, comorbidities, course and therapy in 44 patients. J Eur Acad Dermatol Venereol 2015; 29:2399.
  8. Rongioletti F, Ghigliotti G, De Marchi R, Rebora A. Cutaneous mucinoses and HIV infection. Br J Dermatol 1998; 139:1077.
  9. Yachoui R, Traisak P, Jagga S. Scleredema in a Patient with AIDS-Related Lipodystrophy Syndrome. Case Rep Endocrinol 2013; 2013:943798.
  10. Yu JI, Park W, Lee KK, Park W. Scleredema adultorum of Buschke associated with a carcinoid tumor. Int J Dermatol 2009; 48:784.
  11. Matsunaga J, Hara M, Tagami H. Scleredema of Buschke associated with malignant insulinoma. Br J Dermatol 1992; 126:527.
  12. Manchanda Y, Das S, Sharma VK, Srivastava DN. Scleredema associated with carcinoma of the gall bladder. Br J Dermatol 2005; 152:1373.
  13. Miyagawa S, Dohi K, Tsuruta S, Shirai T. Scleredema of Buschke associated with rheumatoid arthritis and Sjögren's syndrome. Br J Dermatol 1989; 121:517.
  14. Berk MA, Lorincz AL. Scleredema adultorum of Buschke and primary hyperparathyroidism. Int J Dermatol 1988; 27:647.
  15. Haustein UF. Scleroderma-like lesions in insulin-dependent diabetes mellitus. J Eur Acad Dermatol Venereol 1999; 13:50.
  16. Varga J, Gotta S, Li L, et al. Scleredema adultorum: case report and demonstration of abnormal expression of extracellular matrix genes in skin fibroblasts in vivo and in vitro. Br J Dermatol 1995; 132:992.
  17. Kurtoğlu S, Yüksel S, Gündüz Z, et al. Use of high-dose intravenous corticosteroid treatment in a child with scleredema. J Emerg Med 2004; 26:245.
  18. Venencie PY, Powell FC, Su WP, Perry HO. Scleredema: a review of thirty-three cases. J Am Acad Dermatol 1984; 11:128.
  19. Cron RQ, Swetter SM. Scleredema revisited. A poststreptococcal complication. Clin Pediatr (Phila) 1994; 33:606.
  20. Beers WH, Ince A, Moore TL. Scleredema adultorum of Buschke: a case report and review of the literature. Semin Arthritis Rheum 2006; 35:355.
  21. Kövary PM, Vakilzadeh F, Macher E, et al. Monoclonal gammopathy in scleredema. Observations in three cases. Arch Dermatol 1981; 117:536.
  22. Ioannidou DI, Krasagakis K, Stefanidou MP, et al. Scleredema adultorum of Buschke presenting as periorbital edema: a diagnostic challenge. J Am Acad Dermatol 2005; 52:41.
  23. Paz RA, Badra RE, Martí HM, Maxit MJ. [Systemic Buschke's scleredema with cardiomyopathy, monoclonal IgG kappa gammopathy and amyloidosis. Case report with autopsy]. Medicina (B Aires) 1998; 58:501.
  24. Wright RA, Bernie H. Scleredema adultorum of Buschke with upper esophageal involvement. Am J Gastroenterol 1982; 77:9.
  25. Sansom JE, Sheehan AL, Kennedy CT, Delaney TJ. A fatal case of scleredema of Buschke. Br J Dermatol 1994; 130:669.
  26. Weedon D. Cutaneous mucinoses. In: Weedon's Skin Pathology, 3rd ed., Elsevier Limited, 2010. p.353.
  27. Rimon D, Lurie M, Storch S, et al. Cardiomyopathy and multiple myeloma. Complications of scleredema adultorum. Arch Intern Med 1988; 148:551.
  28. Rongioletti F, Merlo G, Cinotti E, et al. Scleromyxedema: a multicenter study of characteristics, comorbidities, course, and therapy in 30 patients. J Am Acad Dermatol 2013; 69:66.
  29. Kreuter A. Localized scleroderma. Dermatol Ther 2012; 25:135.
  30. Bernstein EJ, Schmidt-Lauber C, Kay J. Nephrogenic systemic fibrosis: a systemic fibrosing disease resulting from gadolinium exposure. Best Pract Res Clin Rheumatol 2012; 26:489.
  31. Rho YW, Suhr KB, Lee JH, Park JK. A clinical observation of scleredema adultorum and its relationship to diabetes. J Dermatol 1998; 25:103.
  32. Bray SM, Varghese S, English JC 3rd. Ultrasonic massage and physical therapy for scleredema: improving activities of daily living. Arch Dermatol 2010; 146:453.
  33. Zwischenberger BA, Jacobe HT. A systematic review of morphea treatments and therapeutic algorithm. J Am Acad Dermatol 2011; 65:925.
  34. Eberlein-König B, Vogel M, Katzer K, et al. Successful UVA1 phototherapy in a patient with scleredema adultorum. J Eur Acad Dermatol Venereol 2005; 19:203.
  35. Tuchinda C, Kerr HA, Taylor CR, et al. UVA1 phototherapy for cutaneous diseases: an experience of 92 cases in the United States. Photodermatol Photoimmunol Photomed 2006; 22:247.
  36. Janiga JJ, Ward DH, Lim HW. UVA-1 as a treatment for scleredema. Photodermatol Photoimmunol Photomed 2004; 20:210.
  37. Thumpimukvatana N, Wongpraparut C, Lim HW. Scleredema diabeticorum successfully treated with ultraviolet A1 phototherapy. J Dermatol 2010; 37:1036.
  38. Kochs C, Bockmann A, Hanneken S, Neumann NJ. [Scleredema diabeticorum: successful treatment with UVA-1 phototherapy]. Hautarzt 2011; 62:255.
  39. Kreuter A, Breuckmann F, Uhle A, et al. Low-dose UVA1 phototherapy in systemic sclerosis: effects on acrosclerosis. J Am Acad Dermatol 2004; 50:740.
  40. Kroft EB, Berkhof NJ, van de Kerkhof PC, et al. Ultraviolet A phototherapy for sclerotic skin diseases: a systematic review. J Am Acad Dermatol 2008; 59:1017.
  41. Hager CM, Sobhi HA, Hunzelmann N, et al. Bath-PUVA therapy in three patients with scleredema adultorum. J Am Acad Dermatol 1998; 38:240.
  42. Grundmann-Kollmann M, Ochsendorf F, Zollner TM, et al. Cream PUVA therapy for scleredema adultorum. Br J Dermatol 2000; 142:1058.
  43. Nakajima K, Iwagaki M, Ikeda M, Kodama H. Two cases of diabetic scleredema that responded to PUVA therapy. J Dermatol 2006; 33:820.
  44. Martín C, Requena L, Manrique K, et al. Scleredema diabeticorum in a patient with type 2 diabetes mellitus. Case Rep Endocrinol 2011; 2011:560273.
  45. Xiao T, Yang ZH, He CD, Chen HD. Scleredema adultorum treated with narrow-band ultraviolet B phototherapy. J Dermatol 2007; 34:270.
  46. Yüksek J, Sezer E, Köseoğlu D, et al. Scleredema treated with broad-band ultraviolet A phototherapy plus colchicine. Photodermatol Photoimmunol Photomed 2010; 26:257.
  47. Kokpol C, Rajatanavin N, Rattanakemakorn P. Successful Treatment of Scleredema Diabeticorum by Combining Local PUVA and Colchicine: A Case Report. Case Rep Dermatol 2012; 4:265.
  48. Mattheou-Vakali G, Ioannides D, Thomas T, et al. Cyclosporine in scleredema. J Am Acad Dermatol 1996; 35:990.
  49. Seyger MM, van den Hoogen FH, de Mare S, et al. A patient with a severe scleroedema diabeticorum, partially responding to low-dose methotrexate. Dermatology 1999; 198:177.
  50. Dogra S, Handa S, Kanwar AJ. Dexamethasone pulse therapy for scleredema. Pediatr Dermatol 2004; 21:280.
  51. Breuckmann F, Appelhans C, Harati A, et al. Failure of low-dose methotrexate in the treatment of scleredema diabeticorum in seven cases. Dermatology 2005; 211:299.
  52. Bowen AR, Smith L, Zone JJ. Scleredema adultorum of Buschke treated with radiation. Arch Dermatol 2003; 139:780.
  53. Könemann S, Hesselmann S, Bölling T, et al. Radiotherapy of benign diseases-scleredema adultorum Buschke. Strahlenther Onkol 2004; 180:811.
  54. Angeli-Besson C, Koeppel MC, Jacquet P, et al. Electron-beam therapy in scleredema adultorum with associated monoclonal hypergammaglobulinaemia. Br J Dermatol 1994; 130:394.
  55. Tamburin LM, Pena JR, Meredith R, Soong VY. Scleredema of Buschke successfully treated with electron beam therapy. Arch Dermatol 1998; 134:419.
  56. Lee MW, Choi JH, Sung KJ, et al. Electron beam therapy in patients with scleredema. Acta Derm Venereol 2000; 80:307.
  57. Aichelburg MC, Loewe R, Schicher N, et al. Successful treatment of poststreptococcal scleredema adultorum Buschke with intravenous immunoglobulins. Arch Dermatol 2012; 148:1126.
  58. Venturi C, Zendri E, Santini M, et al. Scleredema of Buschke: remission with factor XIII treatment. Int J Tissue React 2004; 26:25.
  59. Ikeda Y, Suehiro T, Abe T, et al. Severe diabetic scleredema with extension to the extremities and effective treatment using prostaglandin E1. Intern Med 1998; 37:861.
  60. Lee FY, Chiu HY, Chiu HC. Treatment of acquired reactive perforating collagenosis with allopurinol incidentally improves scleredema diabeticorum. J Am Acad Dermatol 2011; 65:e115.
  61. Alsaeedi SH, Lee P. Treatment of scleredema diabeticorum with tamoxifen. J Rheumatol 2010; 37:2636.
  62. Szturz P, Adam Z, Vašků V, et al. Complete remission of multiple myeloma associated scleredema after bortezomib-based treatment. Leuk Lymphoma 2013; 54:1324.
  63. Eastham AB, Femia AN, Velez NF, et al. Paraproteinemia-associated scleredema treated successfully with intravenous immunoglobulin. JAMA Dermatol 2014; 150:788.
  64. Stables GI, Taylor PC, Highet AS. Scleredema associated with paraproteinaemia treated by extracorporeal photopheresis. Br J Dermatol 2000; 142:781.