A 40-year-old woman develops symmetrical woody induration of the neck, shoulders, proximal arms and anterior trunk two weeks after a streptococcal pharyngitis. Her hands, feet and face are completely spared. There is no Raynaud's phenomenon, no sclerodactyly and no nailfold capillary abnormality. Peripheral eosinophilia is absent. The most likely diagnosis is:

• A Diffuse cutaneous systemic sclerosis
• B Eosinophilic fasciitis
• C Generalised morphoea
• D Scleredema of Buschke ✓

Explanation

Scleredema of Buschke typically follows a streptococcal or other infection and produces symmetric, non-pitting induration that characteristically begins on the face, neck and upper trunk while sparing the hands and feet. Unlike systemic sclerosis there is no Raynaud phenomenon, sclerodactyly, capillary abnormality or visceral fibrosis, and unlike eosinophilic fasciitis there is no fascial inflammation, groove sign or peripheral eosinophilia. Histology shows thickened collagen with mucin between bundles.

Reference: Fitzpatrick's Dermatology, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.