Waxy fingers and skin tethering
The patient sought care for a burn he hadn’t felt when he’d held a hot cup of coffee. His history, and the appearance of his hands, suggested a systemic disease at work.
A 73-year-old man with longstanding, poorly controlled type 1 diabetes (T1D) and worsening paresthesia presented to the dermatology clinic following a painless thermal burn of his fingertips from holding a hot cup of coffee. The patient’s paresthesia in a stocking-and-glove distribution was attributable to diabetes-associated polyneuropathy. Two years prior, he had been diagnosed with mildly symptomatic, diabetes-associated scleredema of his upper back and treated with topical corticosteroids.
Physical examination revealed tense bullae on the pads of all 5 digits of his right hand (FIGURE 1). Localized, waxy tightening of the skin was noted on all digits of both hands, along with mild tethering of thickened skin on the right palm.
WHAT IS YOUR DIAGNOSIS?
HOW WOULD YOU TREAT THIS PATIENT?
