Ultrasonographic Findings of Scleredema Adultorum of Buschke Involving the Posterior Neck

Abstract

Objective: To describe the clinical and ultrasonographic (US) findings in patients with scleredema adultorum of Buschke, who presented with sclerotic skin on their posterior neck.

Materials and methods: After obtaining IRB approval, eight patients with scleredema adultorum of Buschke were enrolled. They underwent US examination of their posterior neck. The diagnoses were confirmed pathologically. The clinical history and US images were evaluated retrospectively. Dermal thickness was compared between the patient group and the age- and sex-matched control group.

Results: The patients included seven males and one female with a mean age of 51.5 years. All patients presented with thickening of the skin and/or a palpable mass on the posterior neck. Five (62.5%) of the eight patients showed erythematous discoloration. Six patients (75.0%) had a history of diabetes. The Hemoglobin A1c level was found to be increased in all patients. US images did not show any evidence of a soft tissue mass or infection. The mean dermal thickness in patients (7.01 ± 1.95 mm) was significantly greater than that in the control group (3.08 ± 0.87 mm) (p = 0.001). Multiple strong echogenic spots in the dermis were seen in all patients. Seven patients (87.5%) showed posterior shadowing in the lower dermis.

Conclusion: When a patient with a history of diabetes presents with a palpable mass or erythematous discoloration of the posterior neck and US shows the following imaging features: 1) no evidence of a soft tissue mass or infection, 2) thickening of the dermis, 3) multiple strong echogenic spots and/or posterior shadowing in the dermis, scleredema adultorum of Buschke should be considered in the differential diagnosis.

Keywords: Dermis; Diabetes; Neck; Scleredema; Soft tissue; Ultrasonography.

Fig. 1. 44-year-old man suffering from skin thickening and palpable mass on posterior neck for 1 year.

A. Photograph showing swelling and erythematous change of skin. B. Extended-field-of-view scanning image showing thickening of dermis (double-headed arrow), compared to adjacent control side (black arrow). Partial posterior acoustic shadowing (white arrow) is noted. There is no focal mass or subcutaneous fat edema. C. Multiple echogenic spots (arrows) are observed in thickened dermis (doubleheaded arrow) on ultrasonographic image.

Fig. 2. 46-year-old man suffering from diffuse nuchal skin thickening for 5 months.

He was diagnosed with diabetes 5 years ago. A. Ultrasonographic image showing thickened dermis and marked posterior acoustic shadowing in lower dermis area. There is no vascularity on color Doppler imaging. B. Hematoxylin-eosin stain image with original magnification (× 10) showing thin and unaffected epidermis (arrow) and thickened dermis (double-headed arrow). C. Higher magnification (Hematoxylin eosin stain, × 400) image of lower portion of dermis. Collagen fibers appear swollen and separated by wide spaces. D. Alcian blue stain (× 400) demonstrating multifocal mucin depositions (arrows) between swollen collagen fibers.