Treatment of Scleredema with History of a Preceding Febrile Streptococcal or Viral Respiratory Tract Infection

Clinical Scenario

This protocol covers scleredema arising after a preceding febrile streptococcal or viral respiratory tract infection. The presentation is characterised by symmetrical, woody, non-pitting skin induration beginning on the neck and spreading to the upper trunk, shoulders, and arms, with sparing of the fingers.

Recognising This Presentation

This is the classic post-infectious (Buschke) type of scleredema, which accounts for the majority of cases and affects mainly children and women. Onset is typically abrupt — appearing 1–3 weeks after the febrile respiratory illness — and the course often resolves spontaneously over a period of months.

Treatment approach: When treatment is indicated in this setting, a structured evidence-based protocol is available. The approach includes methotrexate as part of a defined treatment sequence. The complete regimen, clinical decision points, and sequencing are detailed in the full protocol.

Instant Access to Structured Evidence-Based Regimens

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.

Second line: methotrexate (±glucocorticoids, except for diabetic patients)

If this fails, methotrexate is recommended.

View source ↗