title: [Scleredema adultorum Buschke and exulcerated necrobiosis lipoidica in diabetes mellitus type 1].
abstract: METHODS
  A 53-year-old woman suffering from brown plaques occasionally ulcerating at both lower legs and in the course of disease on the back of the foot presented at our department. Moreover she complained about an increasing sclerosis of her skin at the back over the last 15 years. She had suffered from diabetes mellitus type-1 for more than 40 years.
  
  
  METHODS
  Skin biopsies form the ulcerated plaques showed changes typical for necrobiosis lipoidica. Biopsies of the back were diagnosed as scleredema adultorum Buschke. Laboratory tests displayed a normal antinuclear antibody titer. The differential diagnosis of systemic sclerosis could be ruled out.
  
  
  METHODS
  We repeatedly performed debridement of ulcers, cream-PUVA therapy, applied a vacuum-sealing and topical corticosteroids at the lower legs. Meanwhile she received oral pentoxyfillin. The scleredema was treated with UVA-1 phototherapy but had to be stopped for high photosensitivity. Additionally physiotherapy was prescribed. Nonetheless the course of disease was chronic and therapy-resistant.
  
  
  CONCLUSIONS
  Skin diseases are common in diabetes mellitus. Necrobiosis lipoidica and scleredema adultorum Buschke are rare complications but often refractory to treatment.
authors.affiliation: Klinikum für Hautkrankheiten, Universitätsklinikum Jena.
authors.forename: A-K
authors.initials: AK
authors.lastname: Dumke
authors.affiliation: Klinikum für Hautkrankheiten, Universitätsklinikum Jena.
authors.forename: J
authors.initials: J
authors.lastname: Tittelbach
authors.affiliation: Klinikum für Hautkrankheiten, Universitätsklinikum Jena.
authors.forename: P
authors.initials: P
authors.lastname: Elsner
mesh_terms: D001706:Biopsy; D003131:Combined Modality Therapy; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis* / Q000473:pathology; D003937:Diagnosis, Differential; D018450:Disease Progression; D005260:Female; D006801:Humans; D007868:Leg Dermatoses / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D008875:Middle Aged; D009335:Necrobiosis Lipoidica / Q000175:diagnosis* / Q000473:pathology; D012592:Scleredema Adultorum / Q000175:diagnosis* / Q000473:pathology; D012867:Skin / Q000473:pathology