714 - Sclerederma Diabeticorum negative impact on functional recovery during acute inpatient rehabilitation: a case report

Case Diagnosis: Sclerederma diabeticorum is a rare cutaneous manifestation of uncontrolled diabetes mellitus characterized by skin thickening and induration, primarily affecting the upper body and trunk. Its negative impact on functional outcomes has not been clearly documented , nor different treatment modalities to improve motion and strength in such declined patients.



Case Description: 68 y/o obese diabetic male presented to the Rehabilitation Hospital due to functional decline and debility. The patient reported over 15 years of poor glycemic control.
Examination displayed well defined plaques over upper back, neck, shoulders and upper extremities. Skin changes were characterized by thickening, shiny and waxy appearance, with no erythema, pruritus, or tenderness. The remainder of the physical examination was unremarkable.
Laboratory tests showed elevated HbA1c levels (10.5%). Other tests, including complete blood count, liver and kidney function tests, and autoimmune markers, were within normal limits.
Dermatology skin biopsy which revealed dermal fibrosis and thickening with increased collagen deposition, consistent with the scleroderma diabeticorum.
The patient received multidisciplinary therapy with repetitive deep tissue massage, heating, ultrasound and stretching, after which he demonstrated clinical evidence of functional improvement, upper and lower extremity range of motion, strength and was able to ambulate 10 feet with mod assistance



Discussions:

Sclerederma diabeticorum is an uncommon dermatological manifestation of poorly controlled diabetes mellitus. The pathogenesis remains unclear, but it is believed to result from the accumulation of advanced glycation end-products in the skin, leading to collagen deposition and fibrosis. The condition primarily affects the upper body. The mainstay of management involves improving glycemic control, however symptomatic relief can be achieved with aggressive physical therapy to prevent joint contractures.

Conclusions: Early recognition and optimization of glycemic control are crucial in preventing further progression of skin changes and associated complications including functional decline, debility and progressive joint contractures. Long-term follow-up is essential to monitor the patient's progress.