Substantial non-pitting firmness of the skin

Introduction The skin is substantially non-depressed and hard is one of the clinical manifestations of adult scleredema. Adult scleredema is a rare disease characterized by the sudden onset of diffuse symmetrical skin stiffness. It occurs mostly after infectious diseases and can be relieved by itself after several years.

Cause

(1) Causes of the disease

The cause is unknown. According to most patients, after infections (including pharyngitis, impetigo, cellulitis, measles, mumps, etc.), more than half of them are Streptococcus infections. Whether the disease is a manifestation of allergic reaction, or an autoimmune process, or a toxic disorder caused by microbial toxins in the matrix is still controversial, and the exact cause remains to be studied.

(two) pathogenesis

After the onset of infectious diseases, the pathogenesis is still unclear.

an examination

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Most cases often begin to develop symmetrical symmetry in the posterior neck and shoulders within a few days to 6 weeks after acute febrile illness, and quickly spread to the face, neck, scalp, chest and upper arms. Some cases can also affect the abdominal wall, buttocks and chest. The skin is substantially non-depressed and hard, the normal skin pattern disappears, and it is skin-colored, brownish-yellow or pale-white, and the surface is waxy and glossy, and the boundary with normal skin is unclear. Local sensation as usual, no atrophy, inflammation, pigment changes and hair loss. The degree of swelling is often the heaviest in the neck, shoulders, back and face, and it has a hard skin-like feeling. If the face is involved, the expression is missing, and the mask is appearance-like. When the oropharynx and the tongue are involved, the tongue becomes larger and the dysphagia is difficult. If the neck is involved, the neck is inconvenient; if the chest wall is involved, the inhalation is limited. In a few cases, there may be hepatomegaly, skeletal muscle and myocardial involvement, arrhythmia, pleural, pericardial and peritoneal exudation. Occasionally, lesions such as swollen parotid gland.

The disease usually improves within 3 to 6 months after the onset of the disease, most of which disappears within 2 years, and a few cases continue to retreat, or only partially improve, and maintain the residual hard zone for a long time without complete recovery. Have diabetes. Some cases can recur.

According to the skin lesions, they are often applied to the back neck or shoulders, and rapidly develop to the face, chest, back, upper arm, etc., and the progressive symmetry diffuse skin becomes hard, without atrophy, inflammation, pigmentation and hair loss. The local feeling is normal and the diagnosis can be determined.

Differential diagnosis

Skin sclerosis: skin sclerosis is caused by inflammation or degeneration of collagen fibers or adipose tissue; siltation of lymph and blood; and symptoms caused by physical factors and metabolic disorders.

Neonatal skin hyperplasia: This disease mainly occurs in the winter and spring cold season and low age group of newborns, especially premature infants. Clinical manifestations include three major characteristics, namely, body temperature is not rising, skin is swollen and multi-system function damage.

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