Approach Considerations

The lesions of pretibial myxedema (PTM) are primarily of cosmetic concern, although severe elephantiasic forms may lead to significant limb enlargement and impair function. Surgical treatment should be avoided because scarring may aggravate the dermopathy, and benefits are equivocal.

Local application of corticosteroids remains the mainstay of treatment. Compression wraps or stockings that provide 20-40 mm Hg of pressure can be useful as an adjunctive therapy. Fractional laser ablation has been reported as beneficial.^[16]

A dermatologist should be consulted for an evaluation of lesions in suspected PTM and an endocrinologist for an evaluation of possible underlying thyroid disease.

Medication

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Kraus CN, Sodha P, Vaidyanathan P, Kirkorian AY. Thyroid dermopathy and acropachy in pediatric patients. Pediatr Dermatol. 2018 Nov. 35(6):e371-e374. [QxMD MEDLINE Link].
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Lohiya S, Lohiya V, Stahl EJ. Pretibial myxedema without ophthalmopathy: an initial presentation of Graves' disease. Am J Med Sci. 2013 Jul. 346(1):73-5. [QxMD MEDLINE Link].
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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. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
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Ren Z, He M, Deng F, et al. Treatment of pretibial myxedema with intralesional immunomodulating therapy. Ther Clin Risk Manag. 2017. 13:1189-94. [QxMD MEDLINE Link]. [Full Text].
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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. [QxMD MEDLINE Link].
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Media Gallery

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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Author

Ranjodh Singh Gill, MD, FACP, CCD Professor of Internal Medicine and Surgery/Endocrinology, Central Virginia VA Health Care System, Virginia Commonwealth University School of Medicine

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 Former 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: Alpha Omega Alpha, American Academy of Dermatology, Association of Military Dermatologists, Phi Beta Kappa, Texas Dermatological Society

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

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.