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Pretibial Myxedema Medication

  • Author: Ranjodh Singh Gill, MD, FACP, CCD; Chief Editor: Dirk M Elston, MD  more...
 
Updated: Feb 02, 2016
 

Medication Summary

Various medical treatments, including plasmapheresis and cytotoxic therapy, have been tried, but the efficacy of these therapies in pretibial myxedema (PTM)  is unproven. Intralesional or topical therapy with corticosteroids is currently the only treatment that offers demonstrated efficacy.[11, 12] Systemic use should be avoided because of undesirable adverse effects.

Combinations reported as helpful include oral pentoxifylline and topical clobetasol propionate ointment[13, 14] and pentoxifylline with intralesional triamcinolone acetonide.[15]

Newer treatment regimens that are promising but require further investigation include octreotide, a somatostatin analog, and high-dose intravenous immunoglobulin (IVIG).[16] 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[17, 18] ; however, others do not.[19] 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.[20]

The mongraphs below are a few examples of topical preparations available (in order of decreasing potency).[21, 22]

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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).

Betamethasone topical (Diprolene)

 

Topical betamethasone is for inflammatory dermatoses responsive to steroids. It decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. It affects the production of lymphokines and has an inhibitory effect on Langerhans cells. Use 0.05% cream or ointment. Betamethasone has similar potency to clobetasol and halobetasol.

Fluocinonide (Fluonex, Lidex)

 

Fluocinonide is a high-potency topical corticosteroid that inhibits cell proliferation; it is immunosuppressive and anti-inflammatory. Use 0.05% ointment or gel. Fluocinonide has similar potency to mometasone and fluticasone.

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

 

Topical hydrocortisone is an adrenocorticosteroid derivative suitable for application to skin or external mucous membranes. It has mineralocorticoid and glucocorticoid effects resulting in anti-inflammatory activity.

Triamcinolone topical (Kenalog)

 

Topical triamcinolone is for inflammatory dermatoses responsive to steroids; it decreases inflammation by suppressing the migration of polymorphonuclear leukocytes and reversing capillary permeability. Use 0.1% ointment.

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Contributor Information and Disclosures
Author

Ranjodh Singh Gill, MD, FACP, CCD Associate Professor of Medicine, Division of Endocrinology, Virginia Commonwealth University School of Medicine and McGuire Veterans Administration Medical Center; Consulting Staff, Department of Internal Medicine, Virginia Commonwealth University Health System

Ranjodh Singh Gill, MD, FACP, CCD is a member of the following medical societies: American Association of Physicians of Indian Origin, American College of Physicians, Endocrine Society, International Society for Clinical Densitometry, Medical Society of Virginia, North American Sikh Medical and Dental Association, Richmond Academy of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

David F Butler, MD Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic

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

Disclosure: Nothing to disclose.

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

Christen M Mowad, MD is a member of the following medical societies: Alpha Omega Alpha, Noah Worcester Dermatological Society, Pennsylvania Academy of Dermatology, American Academy of Dermatology, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

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

Disclosure: Nothing to disclose.

Additional Contributors

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.

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, Association of Military Dermatologists

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, Uniformed Services Academy of Family Physicians

Disclosure: Nothing to disclose.

Acknowledgements

Purnima Sau, MD Associate Professor, Department of Clinical Dermatology, Uniformed Services University of the Health Sciences

Disclosure: Nothing to disclose.

Laurel R Stearns, DO ResidentPhysician, Department of 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.

References
  1. Doshi DN, Blyumin ML, Kimball AB. Cutaneous manifestations of thyroid disease. Clin Dermatol. 2008 May-Jun. 26 (3):283-7. [Medline].

  2. Kamath C, Young S, Kabelis K, Sanders J, Adlan MA, Furmaniak J, et al. Thyrotrophin receptor antibody characteristics in a woman with long-standing Hashimoto's who developed Graves' disease and pretibial myxoedema. Clin Endocrinol (Oxf). 2012 Sep. 77(3):465-70. [Medline].

  3. 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].

  4. 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. 1995 Sep. 105(3):372-8. [Medline].

  5. Subramanyam S, Lohiya V, Stahl EJ. Pretibial Myxedema Without Ophthalmopathy: An Initial Presentation of Graves' Disease. Am J Med Sci. 2013 Mar 19. [Medline].

  6. Sendhil Kumaran M, Dutta P, Sakia U, Dogra S. Long-term follow-up and epidemiological trends in patients with pretibial myxedema: an 11-year study from a tertiary care center in northern India. Int J Dermatol. 2015 Aug. 54 (8):e280-6. [Medline].

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

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

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

  10. Ai J, Leonhardt JM, Heymann WR. Autoimmune thyroid diseases: etiology, pathogenesis, and dermatologic manifestations. J Am Acad Dermatol. 2003 May. 48 (5):641-59; quiz 660-2. [Medline].

  11. Lan C, Li C, Chen W, Mei X, Zhao J, Hu J. A Randomized Controlled Trial of Intralesional Glucocorticoid for Treating Pretibial Myxedema. J Clin Med Res. 2015 Nov. 7 (11):862-72. [Medline].

  12. Ramos LO, Mattos PC, Figueredo GL, Maia AA, Romero SA. Pre-tibial myxedema: treatment with intralesional corticosteroid. An Bras Dermatol. 2015 Jun. 90 (3 Suppl 1):143-6. [Medline].

  13. 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. 2007 Nov. 21(10):1441-3. [Medline].

  14. Türke B, Balázs C. [Treatment of pretibial myxoedema with pentoxifylline]. Orv Hetil. 2012 Oct 28. 153(43):1719-22. [Medline].

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

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

  17. 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. 1994 Jul. 131(1):52-6. [Medline].

  18. 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. 2000 Nov. 143(5):1083-6. [Medline].

  19. 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. 2003 May. 13(5):465-70. [Medline].

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

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

  22. 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].

 
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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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