This presentation involves a history of a preceding febrile streptococcal or viral respiratory tract infection, followed by symmetrical, woody, non-pitting skin induration that begins on the neck and spreads to the upper trunk, shoulders, and arms — with the fingers typically spared.
Type 1 scleredema — the classic Buschke form — usually follows a febrile infection, particularly streptococcal or viral respiratory in origin. Induration appears suddenly, typically 1–3 weeks after the respiratory illness. This subtype predominantly affects children and women, and in many cases resolves within months.
When management is indicated, treatment selection is guided by a risk-benefit evaluation. The protocol includes systemic pharmacological and physical treatment modalities — the complete structured regimen, including the full range of options, is available via the link below.
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.
If methotrexate fails or is contraindicated, based on a risk–benefit approach, the following alternative treatments can be proposed: glucocorticoids, systemic or intralesional, cyclosporine, prostaglandin E1, intravenous immunoglobulins, high-dose penicillin, factor XIII infusion, cyclophosphamide, tranilast, thalidomide, bortezomib, radiotherapy, extracorporeal shock wave therapy, electron-beam radiotherapy and extracorporeal photopheresis.
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