Health condition
Scleredema adultorum
Scleredema adultorum (of Buschke) is a rare condition in which the skin of the upper back, neck and shoulders becomes diffusely thickened and woody; it follows streptococcal infection in some, accompanies monoclonal gammopathy in others, and its commonest modern form is linked to long-standing diabetes.
Why trust this guide
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Editorial team
Written by our editorial team from the UK sources listed on each page.
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Sourced from guidance
Checked against current NHS and UK specialist society guidance at the time of review.
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Current for 2026
Reviewed on 2026-09-27 with the next review scheduled for 2027-09-27.
Key facts
The essentials at a glance.
The symptoms to recognise, when to seek help, which specialist to see, and what treatment usually involves.
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Symmetrical, non-pitting, woody induration of the upper back, neck and shoulders - the skin cannot be pinched into a fold
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Three settings: post-infectious (often streptococcal, may resolve spontaneously), associated with monoclonal gammopathy, and diabetes-associated (scleredema diabeticorum, usually persistent)
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It is distinct from scleroderma: no Raynaud phenomenon, no sclerodactyly, and antinuclear antibodies are typically negative
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Workup includes HbA1c, serum protein electrophoresis and streptococcal serology; phototherapy (UVA1 or PUVA) is the best-supported treatment
Understanding the condition
What it is and what happens next.
What causes it, how it is diagnosed, and the treatment routes available in the UK.
What it is and how it feels
The thickening in scleredema comes from mucin - a gel-like substance deposited between collagen bundles - which turns the upper back into a stiff, peau d’orange plate that can restrict shoulder movement and, rarely, chest expansion. People often notice difficulty turning the neck or a collar becoming tight rather than any skin colour change, and the condition is regularly missed for years in diabetic clinics.
Diagnosis and treatment routes
A deep biopsy confirms mucin deposition and thickened collagen, and the laboratory search for the three associations shapes management: antibiotics have no role once post-streptococcal disease is established, but paraproteins need haematology review, and tightening glycaemic control is sensible though not reliably curative in the diabetic form. UVA1 or bath-PUVA phototherapy with physiotherapy to preserve shoulder range has the most consistent evidence; methotrexate and electron-beam therapy are reserved for progressive restrictive disease. In much of the UK, a routine NHS referral to the relevant specialist clinic can take several months, whereas an initial appointment with a private consultant is typically available within around two weeks.
Seeing a specialist
Who to see, and how quickly you can be seen.
The specialist for this condition is usually a consultant dermatologist. Your GP can refer you on the NHS, or you can arrange a private consultation directly.
A quiet reminder
This guide is for information, not medical advice.
Your GP knows your history and can tell you which parts apply to you. If in doubt, see them - and seek urgent care for any of the emergency symptoms described above.
Frequently asked
Common questions about Scleredema adultorum.
Quick, plain-English answers to what people ask us most.
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What is scleredema adultorum?
Scleredema adultorum (of Buschke) is a rare condition in which the skin of the upper back, neck and shoulders becomes diffusely thickened and woody, most often linked with diabetes or a recent infection.
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What causes scleredema adultorum?
It results from mucin deposition in the skin, and is commonly associated with poorly controlled diabetes, a preceding streptococcal or other infection, or occasionally an underlying blood disorder.
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What are the symptoms of scleredema adultorum?
Symptoms include a symmetrical, diffuse thickening and hardening of the skin, typically starting on the upper back and neck, which can restrict movement in more extensive cases.
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Is scleredema adultorum dangerous?
It is not usually dangerous but can restrict movement if extensive, and its association with diabetes or an underlying blood disorder means it's worth checking for these conditions if not already known.
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How is scleredema adultorum treated?
Treatment includes optimising blood sugar control if diabetes-related, and for persistent cases, various treatments including phototherapy or other targeted therapies, though response can vary between individuals.
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Scleredema adultorum vs scleroderma - what's the difference?
Despite the similar name, scleredema is a distinct condition from scleroderma, typically linked to diabetes or infection rather than autoimmune disease, and doesn't usually involve the internal organ complications seen in scleroderma.
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When should I see a specialist about scleredema adultorum?
See a doctor for unexplained skin thickening of the upper back and neck, especially with known diabetes. A private dermatologist can typically be seen within about two weeks.