Scleroderma-like Changes in Insulin-dependent Diabetes Mellitus: Clinical and Biochemical Studies

  1. Angela Castellano, M.D.
  1. Division of Endocrinology and Metabolism, Division of Rheumatology, Division of Pulmonary and Neonatal Medicine, Division of Pathology, and the Division of Dermatology, Childrens Hospital of Los Angeles, and the Department of Medicine, Division of Dermatology, Harbor-UCLA Medical Center Torrance, California
  1. Address reprints requests to Bruce A. Buckingham, M.D., Department of Endocrinology, Childrens Hospital of Orange County, P.O. Box 5700, Orange, California 92667.

Abstract

Children with insulin-dependent diabetes mellitus (IDDM) were examined for scleroderma-like changes of digital sclerosis and joint contractures. Of the 104 patients, 19 (18%) demonstrated these features; five patients had both multiple joint involvement and skin changes; three were studied in detail. All three had restrictive pulmonary disease. Histopathology of skin in these three patients demonstrated increased accumulation of collagen in the lower dermis. In two of the patients, the extractability of collagen in 0.5 N acetic acid was decreased by about 50% as compared with normal controls, which suggests increased cross-linkage of collagen. In addition, the mean nonenzymatic glycosylation of collagen in these three patients was 13 times that of controls. The results indicate that distinct histopathologic and biochemical changes can be detected in the skin of these patients. The results further support the hypothesis that nonenzymatic glycosylation may alter the turnover of collagen, thus contributing to the development of a scleroderma-like syndrome with skin, joint, and pulmonary findingsin patients with IDDM.

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