Scleredema Following a Preceding Febrile Streptococcal or Viral Respiratory Tract Infection
This protocol addresses scleredema presenting after a recent febrile streptococcal or viral respiratory tract infection — the classic Type 1 (Buschke) pattern. The presentation is characterised by symmetrical, woody, non-pitting skin induration beginning at the neck and extending to the upper trunk, shoulders, and arms, with the fingers typically spared.
Clinical Scenario
Type 1 scleredema (the Buschke type, ~55% of cases) classically follows a febrile infection — especially streptococcal or viral respiratory illness — and occurs predominantly in children and women. Onset is abrupt, typically 1–3 weeks after the respiratory infection, and the condition generally resolves spontaneously within months.
Treatment Approach
Because this form of scleredema is generally self-limited, specific intervention is often not required. Where treatment is considered appropriate, the approach centres on physical methods to support joint mobility — along with management of any identified underlying condition.
Complete treatment sequencing and clinical decision criteria are available in the full protocol.
References
DOI: 10.1111/jdv.19937
- Type 1 scleroedema (the classic 'Buschke' type, 55% of cases) usually follows a febrile infection, especially streptococcal or viral respiratory tract infection, and affects mainly children and women.
- Type 1 scleroedema starts suddenly 1–3 weeks after respiratory infection with fever and usually resolves in a few months.
- Scleroedema type 1 does not usually require treatment, as it is self-limited and usually resolves in a short period of time.
- If the patient wishes to have therapy, physical therapy (and sometimes also phototherapy) can be recommended.
- Physical therapy is recommended for all three types of scleroedema, in order to improve the mobility of patients.
- In addition, appropriate treatment should be performed if an associated condition could be identified (infection in type 1 scleroedema, a lymphoproliferative disorder in type 2, or diabetes mellitus in type 3).
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