Complex regional pain syndrome is characterized by chronic, disabling pain, swelling, and motor impairment that frequently affect the hand, often secondary to surgery or trauma.5,7 This diagnosis differs from the generally painless skin hardening of diabetic hand.
The co-existence of diabetic scleredema and diabetic sclerodactyly has been previously reported, although the onset of each condition is often temporally distinct.8 In contrast to diabetic sclerodactyly, the firm indurated skin characteristic of diabetic scleredema (which our patient had) initially involves the shoulders and neck and may progress over the trunk, including the upper back, typically sparing the distal extremities. Of note, the dermis in scleredema is thickened with marked deposition of mucopolysaccharide.9
Glycemic control is paramount
Studies of patients with diabetes who have thick, waxy skin and LJM have shown that tight glycemic control may reduce skin thickness and palmar fascia fibrosis.3,5,9 Thus, in this patient with poorly controlled T1D, diabetic sclerodactyly, early DC, and second-degree burns attributable to advanced polyneuropathy, tightened glycemic control is logical and warranted. Such control could potentially impact the trajectory and morbidity of skin and musculoskeletal manifestations in this broad-reaching disease.
Although there are limited treatments for mobility-related symptoms of diabetic hand syndrome, physiotherapy is recommended in more severe stages of disease to increase joint range of motion.4,5 More severe cases of DC and trigger finger have been successfully treated with topical steroids, corticosteroid injections, and surgery.4,5 Simply stated—and in line with compulsive foot care—the diabetic milieu necessitates clinicians’ close attention to the hands. Components of diabetic hand, LJM, DC, or trigger finger may indicate a need to screen not only for diabetes in a patient previously undiagnosed but also, importantly, for other sequelae of diabetes, including retinopathy.4,5
Our patient was treated with a moderate-potency topical steroid, triamcinolone 0.1% cream, and was advised to continue optimizing glycemic control with the aid of his primary care physician. It was unclear whether the patient improved with use, as he was lost to follow-up.