A localized cutaneous scleroderma in woman after diatomaceous dust oral consumption: a case report

Background: Scleroderma-like disorders are heterogenous diseases characterized by sclerosis of the dermis, subcutis and sometimes the underlying soft tissues and bones. The clinical course of diseases may range from a benign local disease to a widespread systemic, life-threatening disease. There is a high risk of developing a systemic disease indistinguishable from idiopathic scleroderma in miners in coal and gold mines exposed to silica dust (silicon dioxide SiO2). Several cases of scleroderma morphea (circumscripta), a localized form with limited areas of skin sclerosis without Raynaud's phenomenon or visceral involvement, have described in response to inhalatory exposure to silica dust. A 52-year-old woman was admitted to Rheumatology Clinic for clinical investigation of skin thickening on the abdomen, chest, and proximal thighs, along with pain, redness, and mild itching, a few months after taking fossil shell dust for six months, purchased from a pharmacy in Sofia. The instructions for use state that the product is a natural mineral – not a food, medicine, or dietary supplement that can be used as an additive in animal feed (for birds and mammals) with an anti-adhesive effect, and that it has a number of applications in the food industry. The patient took a level tablespoon of the contents of the package, dissolved in a glass of water, once a day – approximately 10 g of dust. The clinical skin findings consisted of violaceous erythema-infiltrative plaques. The histological diagnosis after skin biopsy of a lesion was scleroderma circumscripta. The chemical analysis of the skin sample showed a silicon content about ten times more than normal.