Scleroderma-like lesions in insulin-dependent diabetes mellitus

We report on two patients (one female 42 years, one male 47 years) sufferin g from insulin-dependent diabetes mellitus (IDDM) for more than 20 years. B oth patients exhibited sclerodactyly and sclerosis of the hands and lower a rms as well as swelling and slight contracture of the distal interphalangea l joints. Interestingly, internal organs were not involved and autoantibodi es characteristic for scleroderma were missing. Poor utilization and excess of glucose seem to be responsible for the activation of fibroblasts to pro duce abundant matrix proteins in the skin. Significant therapeutic improvem ent of the glucose metabolism was able to improve joint contractures or at least to stop the progression of skin changes in our patients. These skin c hanges should not be misdiagnosed as systemic sclerosis. (C) 1999 Elsevier Science B.V. All rights reserved.