e40 Care Volume 41, April 2018

Successful Treatment of Scleredema Min Sun, Feng Yang, and Maihua Hou Diabeticorum With Tranilast: Three Case Reports Diabetes Care 2018;41:e40–e41 | https://doi.org/10.2337/dc17-1994

Scleredema is a rare disease that is char- (we used the recommended dose for softness and we could objectively moni- acterized by symmetrical and nonpitting the treatment of keloids and asthma to tor changes in thickness by ultra- induration of the skin due to thickened ensure its safety) without any other sound imaging. The mechanism of tranilast dermis with abundant mucin deposition drugs. The patient’s skin was softened af- remains to be clarified; it may be related among large bundles (1). Al- ter 3 months’ treatment and ultrasound to the inhibition and regulation of collagen though many methods have been tried, images showed that his skin thickness as reported (3,4), thus resulting in a reduc- there is currently no standard treatment. was reduced to 6.7 mm. tion in the thickness of the skin. This is the We report three cases of scleredema The second patient was a 49-year-old first report showing that tranilast treat- diabeticorum treated with tranilast. It is man with type 2 diabetes complaining ment can benefit patients with scleredema well established that histopathology of of a progressive thickening of his poste- diabeticorum, and it provides a new idea pathogenic skin in patients with sclere- rior neck, deterioration in his everyday for the of this disease. There is also dema diabeticorum shows collagen fiber routines, and discomfort. The biopsy a need to expand the number of clinical thickening and type I collagen metabo- also showed an expanded reticular dermis cases to demonstrate the precise efficacy. lism abnormalities. In our inspection, with abundant mucin deposition among ahigherlevelofTGF-b can be seen thickened collagen bundles. Epidermal by immunohistochemistry in patients thickness was 7.0 mm. After treatment Funding. This work was supported by National Natural Science Fund (31371383), Jiangsu pro- with scleredema diabeticorum compared with tranilast (0.3 g/day) for 3 months, vincial Six Talent Peaks (2013-WSN-031), and with healthy patients. It has been re- however, the condition of the skin started Jiangsu Education Science 12th Five-Year pro- ported that tranilast was able to suppress improving, showing a progressive normal- gram (D/2013/01/015). the TGF-b–induced upregulation of type I ization of cutaneous softness, and ultra- Duality of Interest. No potential conflicts of in- collagen mRNA expression and the basal soundimagesshowedskinthicknesswas terest relevant to this article were reported. Author Contributions. M.S. managed the pa- level of type I collagen mRNA in human reduced to only 6.0 mm. tients, collectedrelevant information, and wrote dermal fibroblasts (2). We treated the third patient in the the manuscript. F.Y. analyzed the data and wrote A 45-year-old man with type 2 diabetes same way. She was a 62-year-old woman the manuscript. M.H. designed the experiment visited our hospital and told us that his with a history of chronic and poorly con- and the diagnosis and treatment of this disease, posterior neck and upper back had pro- trolled diabetes who complained of a pro- reviewed the data and manuscript, and approved the final version. M.H. is the guarantor of this work gressive thickening and wooden indura- gressive thickening of her skin, worsening and takes responsibility for the integrity of the data

OBSERVATIONS tion for 5 years. A skin biopsy showed daily life activities. Through our treat- and the final version of the manuscript. – an expanded reticular dermis and thick- ment, the patient felt that the symptoms ened collagen bundles. Epidermal thick- of restricted movement were reduced, References ness was 8.7 mm. Because there is no and her skin thickness got 0.6 mm thinner 1. Gandolfi A,PontaraA,DiTerlizziG,etal.Im-

e-LETTERS provement in clinical symptoms of scleredema standard therapy, the patient did not take than before. diabeticorum by frequency-modulated electro- other except hypoglycemic In the three cases, all patients had a magnetic neural stimulation: a case report. Diabe- drugs. We gave him tranilast 0.3 g/day progressive normalization of cutaneous tes Care 2014;37:e233–e234

Department of , The First Affiliated Hospital, Nanjing Medical University, Nanjing, Jiangsu, China Corresponding author: Maihua Hou, [email protected]. Received 27 September 2017 and accepted 28 December 2017. M.S. and F.Y. are co-first authors. © 2018 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at http://www.diabetesjournals.org/content/license. care.diabetesjournals.org Sun, Yang, and Hou e41

2. Chung KY, Kang DS. Regulation of type I colla- 3. Yamada H, Tajima S, Nishikawa T, Murad S, 4. Suzawa H, Kikuchi S, Arai N, Koda A. The mech- gen and interstitial collagenase mRNA expression Pinnell SR. Tranilast, a selective inhibitor of colla- anism involved in the inhibitory action of tranilast in human dermal fibroblasts by colchicine and gen synthesis in human skin fibroblasts. J Biochem on collagen biosynthesis of keloid fibroblasts. Jpn D-penicillamine. Yonsei Med J 1999;40:490–495 1994;116:892–897 J Pharmacol 1992;60:91–96