Progressive Systemic Sclerosis: Pseudoscleroderma

Scleredema: report of a case

Abstract We describe a patient with scleredema. Thickened skin was observed in the posterior region of her neck, shoulders, and back. A skin biopsy revealed thickened dermis consisting of numerous thickened collagen bundles. Laboratory data revealed that she was suffering from diabetes mellitus (DM). The skin lesions ameliorated within a period of one month when her DM condition was controlled by oral hypoglycemics. Scleredema is a rare connective tissue disorder; its cutaneous manifestation should be distinguished from scleroderma.

Histologic and immunofluorescence study of cutaneous porphyrias

We reviewed the histologic and direct immunofluorescence findings in skin biopsy specimens from 24 patients with cutaneous porphyrias. The histopathologic changes were characterized by cell-poor subepidermal bullae, festooning of dermal papillae, thickening and hyalinization of dermal blood vessel walls, dermal sclerosis, and a mild perivascular infiltration of mononuclear cells in the upper dermis. The characteristic pattern on direct immunofluorescence testing was fluorescence of thickened doughnut-like blood vessels in the upper dermis, reflecting deposition of immunoglobulins and C3, and deposition of immunoglobulins or C3 or both at the dermal-epidermal junction in most cases. These findings are characteristic but not specific for the porphyrias; they may also be observed in the pseudoporphyria syndromes and in other clinical settings. However, the immunopathologic findings are distinctive enough to be useful in differentiating the porphyrias and pseudoporphyria syndromes from other subepidermal bullous diseases such as epidermolysis bullosa acquisita and bullous pemphigoid. The most important diagnostic test in the evaluation of the cutaneous porphyrias still is measurement of porphyrins in urine, stool, and blood.