Dear Editor: Scleredema is characterized by non-pitting hardening of the skin that typically begins on the neck and subsequently spreads to the shoulders, back, and face. Histopathologically, it is characterized by excessive mucin deposition between collagen bundles. It is clinically classified into 3 types:postinfectious (type I), paraproteinemia-associated (type II), and diabeticorum (type III)1,2,3,4. Here, we report a case of of following a streptococcal infection. An 8-year-old boy presented with a 1-week history of skin firmness of the whole body. He experienced a febrile upper-respiratory infection 2 months prior with abrupt onset of skin hardening starting from his posterior neck and rapidly extending to his face, trunk, arms, and legs. On physical examination, whole-body and non-pitting induration of the skin were noted, especially on the posterior neck and upper back (Fig. 1). A biopsy from the posterior neck revealed dermal thickening with a square-like appearance, and a high-magnification view revealed slight widening of collagen bundles with normal fibroblast number (Fig. 2A, B). Mucin deposition was detected between collagen bundles (Fig. 2C). No other laboratory abnormalities except an elevated antistreptolysin O titer (476 U/L [normal range: 0~160 U/L]) were noted. Therefore, he was diagnosed with of following a streptococcal infection. Fig. 1 Whole-body and non-pitting induration of the skin was noted including face. On physical examination, it was hard to pinch his check. Fig. 2 (A) Skin biopsy specimen revealed a non-tapered appearance on a low-power field (H&E, ×40). (B) Fibroblasts were normal in number, and the spaces between collagen bundles were widened (H&E, ×400). (C) Mucin deposits were ... Scleredema is also termed of Buschke, adultorum, or of Buschke. The term adultorum was suggested by in 1902 to distinguish this entity from sclerema neonatorum2,3. It is usually classified into 3 types; however, the nomenclature of each subgroup has not been established. Moreover, classification systems differ among sources. Type I, known as the classic type, is characterized by a sudden onset of skin hardening after an acute febrile illness in children and adolescents. The preceding infection is usually bacterial or viral in origin, most commonly a streptococcal upper-respiratory infection. Thus, we suggest referring to this type postinfectious scleredema,1 to distinguish it from other types of or restricting the use of the term of Buschke to describe type I as it was first described by himself. Furthermore, the term adultorum should be avoided because it may cause confusion among physicians. Meanwhile, type II has an insidious onset and is usually associated with paraproteinemia, hypergammaglobulinemia, or multiple myeloma. Finally, type III scleredema, also called diabeticorum, is related to poorly controlled type 2 diabetes. However, there are other cases associated with insulinoma, secondary hyperparathyroidism, rheumatoid arthritis, or HIV infection that do not meet the criteria of any of the above mentioned type4. Type I is usually resolved within 2 years and does not require treatment. Thus, our patient has not been treated and has shown a resolution of symptoms over the past 5 months. If symptoms persist, phototherapy including psoralen plus ultraviolet A, ultraviolet A-1, and narrow-band ultraviolet B as well as radiotherapy and intravenous immunoglobulins should be considered. In conclusion, a classification system for must be established. In addition, type I should be named postinfectious scleredema or of Buschke.