Lichen Myxedematosus Treatment & Management

Updated: Mar 11, 2019
  • Author: Elizabeth A Liotta, MD; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

The treatment of lichen myxedematosus is difficult and often ineffective. Many therapeutic approaches have been tried.

Melphalan used to be the main treatment for scleromyxedema; however, it may have contributed to patients deaths from inducement of hematologic malignancies. [5]

These approaches include treatment with retinoids, orthovoltage radiation, [6] electron beams, high-dose dexamethasone, psoralen UV-A (PUVA), plasmapheresis, extracorporeal photophoresis, dermabrasion, and carbon dioxide laser excision. [7] Therapeutic improvements have been reported with the use of intravenous immunoglobulins with or without thalidomide or, more recently, lenalidomide, an analogue of thalidomide. [5, 8, 9]  Successful treatment is reported with melphalan, dexamethasone, and thalidomide maintenance therapy. [10]

High-dose melphalan followed by autologous stem cell transplantation was reported as effective. [11]

Topical tacrolimus reportedly has been successful in treating localized disease in a few patients. [12]

Various reports in the literature describe treatment successes and failures with these methods.

A 2004 article reported improvement with thalidomide in 3 patients in whom other therapies had failed. All 3 showed marked improvement of skin lesions within the first 2 months of therapy and continued improvement after 4 months of therapy. The doses of thalidomide ranged from 100 mg at bedtime to 400 mg in divided doses; the adverse effects were better tolerated at the 200-mg/d dose in divided doses. [13] Adverse effects of thalidomide most commonly include mild sedation and constipation. Thalidomide is also teratogenic.

Finally, nerve conductions studies have revealed the occurrence of peripheral neuropathy in approximately 25% of patients. In a different 2004 study, high-dose dexamethasone was helpful in 1 patient, who received the drug for 3 weeks, after which it was tapered to a lower dose for 4 months. [14]

A case report using lenalidomide and intravenous immunoglobulins showed significant improvement with persistent remission and no recurrence after 24 months. The lenalidomide has fewer adverse effects than thalidomide, with less neuropathy, somnolence, and constipation. [9]

Intravenous immunoglobulin therapy for scleromyxedema is well documented, although the mechanism of action is not clear. It has been used alone, with thalidomide, or with lenalidomide. [5, 9]

Another consideration, as demonstrated by a case report, was resolution of an atypical case of lichen myxedematosus following treatment for a concomitant infection of hepatitis C with sofosbuvir-velpatasvir therapy. [15]

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Consultations

Patients should be referred to an internal medicine specialist for a thorough physical examination.

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Long-Term Monitoring

Patients should undergo periodic follow-up. Patients should be referred to specialists for evaluation as needed for specific systemic complaints.

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