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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Kamath C, Young S, Kabelis K, 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].
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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. [Medline].
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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].
Ferreli C, Pinna AL, Pilloni L, Corbeddu M, Rongioletti F. Obesity-associated lymphedematous mucinosis: two further cases and review of the literature. Dermatopathology (Basel). 2018 Jan-Mar. 5(1):16-20. [Medline]. [Full Text].
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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 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 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, American Society for MOHS Surgery, Association of Military Dermatologists, 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

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.

Pretibial Myxedema Treatment & Management

Approach Considerations

References

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