Pretibial Myxedema Medication

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

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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