Commonly localized in the pretibial area, it is therefore often referred to as pretibial myxedema (PTM). The results of our study were consistent with this pattern, with 83% of patients having had thyroid disease before the development of dermopathy and 72% having had ophthalmopathy before PTM. They were asked as well whether they had any skin problems in the legs (including cosmetic concern, local discomfort, and difficulty in wearing shoes or socks). Endocrinologists usually performed the initial evaluation. This therapy, directed at ophthalmopathy, is likely to result in improvement of associated dermopathy. Mild cases and cases without cosmetic or local functional problems were usually followed by endocrinologists, and topical therapy was not initiated. In 81.0% of those treated by topical corticosteroids, the agents were applied under occlusion. In our previous report (1), involving fewer patients and a shorter follow-up, we found that 38% of patients experienced partial remission of their dermopathy and only 8% had complete remission. Twenty-six percent of the patients experienced complete remission, 24.2% had moderate improvement (partial remission), and 50.0% had no or minimal improvement of their dermopathy at last follow-up. It usually presents itself as a waxy, discolored induration of the skin—classically described as having a so-called peau d'orange (orange peel) appearance—on the anterior aspect of the lower legs, spreading to the dorsum of the feet, or as a non-localised, non-pitting edema of the skin in the same areas. Stimulation of glycosaminoglycan production in cultured human retroocular fibroblasts. (The remaining 17 patients had been diagnosed at this institution earlier.) Hyperpigmentation and hyperkeratosis were also present in some cases, as was hyperhidrosis. Compression was used in some patients and consisted of athletic wraps or compression stockings, providing 20–40 mm Hg pressure.
Successful treatment of exophthalmos and pretibial myxoedema with plasmapheresis. Forty-three patients (24.2%) had moderate improvement but not complete remission at last known follow-up (nine have since died). This too was confirmed by the present study. The reason for such abnormal behavior of the immune system is as yet unknown. All rights reserved. B, Plaque form in pretibial area. Corticoid therapy for pretibial myxedema. (16) also proposed that dependent edema may play a role, causing the slower return of lymph from the lower legs and increasing the half-life of fibroblast-stimulating cytokines locally. Ideally, compression consists of athletic wraps or compression stockings, providing 20–40 mm Hg pressure. In 17%, thyroid acropachy was diagnosed, involving soft tissue swelling of the hands and feet with characteristic radiographic features (1, 5).  In advanced cases, this may extend to the upper trunk (torso), upper extremities, face, neck, back, chest and ears. Graves' dermopathy results from a buildup of certain carbohydrates in the skin — the cause of which isn't known. D, Elephantiasic form. This content does not have an Arabic version. Severe hyperthyroidism can thus cause weak and brittle bones or osteoporosis. The patient’s thyroid function status was noted as euthyroid on no therapy, euthyroid on thyroid replacement, hypothyroid, or hyperthyroid. Application of petroleum jelly on the affected area could relieve the burning sensation and the itching. There are suggestions in the medical literature that treatment with radioactive iodine for Graves' hyperthyroidism may be a trigger for pretibial myxedema which would be consistent with radioiodine ablation causing or aggravating ophthalmopathy, a condition which commonly occurs with pretibial myxedema and is believed to have common underlying features.. Patients need to take thyroid replacement therapy for the rest of their lives post thyroid gland removal. For these patients, local corticosteroid therapy under occlusion may offer additional help. High-dose iv immunoglobulin treatment (32) and plasmapheresis (33, 34) have also been used to treat PTM in a few patients and have led to improvement or remission of the condition (33). In our study, 10 patients had such a problem, and 21 complained of local discomfort. Graves' dermopathy. Various treatment modalities have been employed, including topical and systemic corticosteroids, compression dressings, and local injections (3–7).
All rights reserved. Surgical excision is not recommended, and local corticosteroid injection is not advised at the present time.
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