Abstract

Background/Objectives: The objective of this scoping review was to systematically map the available evidence for the management of scleredema diabeticorum (SD) to summarize the documented clinical outcomes with the aim to inform clinical practice and identify research gaps. Methods: We conducted a scoping review identifying studies published in English from January 2005 to July 2025 through a comprehensive search of Scopus, MEDLINE, and the Cochrane Library. Eligible studies included randomized controlled trials, observational studies, case series, and case reports on treatment interventions and clinical outcomes. Two reviewers independently screened records, extracted data, and narratively and descriptively synthesized data. Results: Forty-five studies met the inclusion criteria: 39 single-patient case reports, five case series, and one multicenter observational study. The most common interventions were PUVA (8 studies, 14 patients; 12/14 improved, 85.7%), methotrexate (8 studies, 22 patients; 8/22 improved, 36.4%), and improved glycemic control (9 studies, 12 patients; mixed responses). Across small case reports/series, PUVA, UVA-1, and IVIG were most frequently reported as beneficial. Methotrexate monotherapy showed low and inconsistent effectiveness, with higher responses when combined with other agents. Other reported therapies included colchicine, electron-beam radiation, tranilast, and topical hyaluronidase. Conclusions: PUVA, UVA-1, and IVIG may offer benefit, while methotrexate alone is often ineffective. Evidence is predominantly from case reports and small series, which makes it difficult to generalize. Multicenter trials with standardized protocols are needed to develop evidence-based treatment recommendations.