This presentation — termed scleredema diabeticorum — occurs predominantly in men with diabetes mellitus. It is characterised by symmetrical, woody, non-pitting induration of the skin affecting the neck and upper trunk, with the fingers typically spared.
The association with diabetes mellitus defines this subtype. The diabetic context is clinically significant not only for establishing the diagnosis but also for determining which treatment options are and are not appropriate in this population.
A specific disease-modifying agent is used in this setting. Importantly, certain immunosuppressive co-medications commonly combined in other scleredema contexts are specifically withheld in diabetic patients. The full selection criteria, sequencing, and monitoring guidance are in the complete protocol.
Type 3 scleroedema was named 'scleredema diabeticorum' by Krakowski and colleagues, and manifests mostly in men with diabetes mellitus.
Second line: methotrexate (±glucocorticoids, except for diabetic patients)
If this fails, methotrexate is recommended.