Pretibial Myxedema Medication

  • Author: George E vonHilsheimer, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Nov 28, 2011
 

Medication Summary

Various medical treatments, including plasmapheresis and cytotoxic therapy, have been tried, but the efficacy of these therapies is unproven. Intralesional or topical therapy with corticosteroids is currently the only treatment that offers demonstrated efficacy. Systemic use should be avoided because of undesirable adverse effects.

Combinations reported as helpful include oral pentoxifylline and topical clobetasol propionate ointment[5] and pentoxifylline with intralesional triamcinolone acetonide.[6]

Newer treatment regimens that are promising but require further investigation include octreotide, a somatostatin analog, and high-dose intravenous immunoglobulin (IVIG).[7] The basis for use of octreotide stems from research of refractory PTM patients who had increased expression of insulinlike growth factor-1 receptor on up-regulated fibroblasts. Intralesional injections of octreotide have led to decreased amounts of hyaluronic acid within the lesion. Some studies report success with weekly injections, and patients have remained symptom free for up to 15 months[8, 9] ; however, others do not.[10] Surgical removal is generally ill advised because scarring may worsen dermopathy; however, at least one patient with thick plaques prior to surgical shaving of the lesion and daily octreotide injections for 6 months did not have recurrence after 9 years of surveillance.[11]

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Corticosteroids

Class Summary

These agents are applied topically under an occlusive dressing, and they provide symptomatic relief in many patients. A variety of ointments, creams, and gels are available. The following are a few examples of topical preparations available (in order of decreasing potency).[12, 13]

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Betamethasone topical (Diprolene)

 

For inflammatory dermatoses responsive to steroids. Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Affects production of lymphokines and has inhibitory effect on Langerhans cells. Use 0.05% cream or ointment. Similar potency to clobetasol and halobetasol.

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Fluocinonide (Fluonex, Lidex)

 

High-potency topical corticosteroid that inhibits cell proliferation; is immunosuppressive and anti-inflammatory. Use 0.05% ointment or gel. Similar potency to mometasone and fluticasone.

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Hydrocortisone topical (LactiCare HC, Westcort, Dermacort, DermaGel, Cortaid)

 

An adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. Has mineralocorticoid and glucocorticoid effects resulting in anti-inflammatory activity.

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Triamcinolone topical (Kenalog)

 

For inflammatory dermatosis responsive to steroids; decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing capillary permeability. Use 0.1% ointment.

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Contributor Information and Disclosures
Author

George E vonHilsheimer, MD  Assistant Professor of Dermatology, Uniformed Services University of the Health Sciences; Chief, Staff Dermatologist, Department of Medicine, Martin Army Community Hospital, Fort Benning, Georgia

George E vonHilsheimer, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Association of Military Dermatologists

Disclosure: Nothing to disclose.

Coauthor(s)

Laurel R Stearns, DO  Resident in Dermatology, National Capital Consortium

Laurel R Stearns, DO is a member of the following medical societies: American Academy of Dermatology and Association of Military Osteopathic Physicians and Surgeons

Disclosure: Nothing to disclose.

Kathryn K Garner, MD  Staff Physician, Family Health Clinic, Ehrling Bergquist Clinic, Offutt AFB, NE

Kathryn K Garner, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Physicians, and Uniformed Services Academy of Family Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Gregory J Raugi, MD, PhD  Professor, Department of Internal Medicine, Division of Dermatology, University of Washington at Seattle School of Medicine; Chief, Dermatology Section, Primary and Specialty Care Service, Veterans Administration Medical Center of Seattle

Gregory J Raugi, MD, PhD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

David F Butler, MD  Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic

David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Christen M Mowad, MD  Associate Professor, Department of Dermatology, Geisinger Medical Center

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Catherine M Quirk, MD  Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania

Catherine M Quirk, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Purnima Sau, MD, to the development and writing of this article.

References

  1. Komosinska-Vassev K, Winsz-Szczotka K, Olczyk K, Kozma EM. Alterations in serum glycosaminoglycan profiles in Graves' patients. Clin Chem Lab Med. 2006;44(5):582-8. [Medline].

  2. Heufelder AE, Bahn RS, Scriba PC. Analysis of T-cell antigen receptor variable region gene usage in patients with thyroid-related pretibial dermopathy. J Invest Dermatol. Sep 1995;105(3):372-8. [Medline].

  3. Fatourechi V, Bartley GB, Eghbali-Fatourechi GZ, Powell CC, Ahmed DD, Garrity JA. Graves' dermopathy and acropachy are markers of severe Graves' ophthalmopathy. Thyroid. Dec 2003;13(12):1141-4. [Medline].

  4. Missner SC, Ramsay EW, Houck HE, Kauffman CL. Graves' disease presenting as localized myxedema in a thigh donor graft site. J Am Acad Dermatol. Nov 1998;39(5 Pt 2):846-9. [Medline].

  5. Pineda AM, Tianco EA, Tan JB, Casintahan FA, Beloso MB. Oral pentoxifylline and topical clobetasol propionate ointment in the treatment of pretibial myxoedema, with concomitant improvement of Graves' ophthalmopathy. J Eur Acad Dermatol Venereol. Nov 2007;21(10):1441-3. [Medline].

  6. Engin B, Gümüsel M, Ozdemir M, Cakir M. Successful combined pentoxifylline and intralesional triamcinolone acetonide treatment of severe pretibial myxedema. Dermatol Online J. May 1 2007;13(2):16. [Medline].

  7. Antonelli A, Navarranne A, Palla R, Alberti B, Saracino A, Mestre C, et al. Pretibial myxedema and high-dose intravenous immunoglobulin treatment. Thyroid. Winter 1994;4(4):399-408. [Medline].

  8. Priestley GC, Aldridge RD, Sime PJ, Wilson D. Skin fibroblast activity in pretibial myxoedema and the effect of octreotide (Sandostatin) in vitro. Br J Dermatol. Jul 1994;131(1):52-6. [Medline].

  9. Shinohara M, Hamasaki Y, Katayama I. Refractory pretibial myxoedema with response to intralesional insulin-like growth factor 1 antagonist (octreotide): downregulation of hyaluronic acid production by the lesional fibroblasts. Br J Dermatol. Nov 2000;143(5):1083-6. [Medline].

  10. Rotman-Pikielny P, Brucker-Davis F, Turner ML, Sarlis NJ, Skarulis MC. Lack of effect of long-term octreotide therapy in severe thyroid-associated dermopathy. Thyroid. May 2003;13(5):465-70. [Medline].

  11. Felton J, Derrick EK, Price ML. Successful combined surgical and octreotide treatment of severe pretibial myxoedema reviewed after 9 years. Br J Dermatol. Apr 2003;148(4):825-6. [Medline].

  12. Deng A, Song D. Multipoint subcutaneous injection of long-acting glucocorticid as a cure for pretibial myxedema. Thyroid. Jan 2011;21(1):83-5. [Medline].

  13. Takasu N, Higa H, Kinjou Y. Treatment of pretibial myxedema (PTM) with topical steroid ointment application with sealing cover (steroid occlusive dressing technique: steroid ODT) in Graves' patients. Intern Med. 2010;49(7):665-9. [Medline].

  14. Fatourechi V, Pajouhi M, Fransway AF. Dermopathy of Graves disease (pretibial myxedema). Review of 150 cases. Medicine (Baltimore). Jan 1994;73(1):1-7. [Medline].

  15. Heymann WR. Advances in the cutaneous manifestations of thyroid disease. Int J Dermatol. Sep 1997;36(9):641-5. [Medline].

  16. Kriss JP. Pathogenesis and treatment of pretibial myxedema. Endocrinol Metab Clin North Am. Jun 1987;16(2):409-15. [Medline].

  17. Malkinson FD, Furey N. Pretibial myxedema. Arch Dermatol. Dec 1967;96(6):737-8. [Medline].

  18. Schwartz KM, Fatourechi V, Ahmed DD, Pond GR. Dermopathy of Graves' disease (pretibial myxedema): long-term outcome. J Clin Endocrinol Metab. Feb 2002;87(2):438-46. [Medline].

  19. Smith TJ, Bahn RS, Gorman CA. Connective tissue, glycosaminoglycans, and diseases of the thyroid. Endocr Rev. Aug 1989;10(3):366-91. [Medline].

  20. Somach SC, Helm TN, Lawlor KB, Bergfeld WF, Bass J. Pretibial mucin. Histologic patterns and clinical correlation. Arch Dermatol. Sep 1993;129(9):1152-6. [Medline].

 
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Bilateral erythematous infiltrative plaques in the pretibial areas.
Deposition of mucin in the reticular dermis (hematoxylin and eosin stain, original magnification X25).
Blue staining of mucin with colloidal iron stain (original magnification X25).
 
 
 
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