A Randomized Controlled Trial of Intralesional Glucocorticoid for Treating Pretibial Myxedema

Lan, Changgui; Li, Can; Chen, Wei; Mei, Xiaofeng; Zhao, Jing; Hu, Jie

doi:10.14740/jocmr2303w

Cited by 15 publications

(12 citation statements)

References 17 publications

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“…Multiple modalities of PTM treatment have been reported that include minimizing risk factors (smoking, obesity), topical steroids, intralesional steroids (triamcinolone, betamethasone) [34], plasmapheresis, intravenous immunoglobulin (IVIg), surgery [35], UVA1, compression bandages, and massage therapy. Glucocorticoid inhibiting TSHR autoimmunity and HA synthesis can lower serum TRAb levels and improve PTM [6,36].…”

Section: Diagnosis and Treatmentmentioning

confidence: 99%

Thyroid-Stimulating Hormone Receptor Autoimmunity and Local Factors in Multiple Risk Factors Are Mainly Involved in the Occurrence of Pretibial Myxedema

Lan

Liao

et al. 2020

J Clin Med Res

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Background: Pretibial myxedema (PTM) is a local mucinous dermopathy associated with thyroid diseases. Since the etiology of PTM is unclear, the aim of this study is to identify the risk factors for PTM and their etiological roles in PTM occurrence. Methods: A large-scale case-control study (n = 1,200) was performed to identify risk factors for PTM by calculating odds ratio (OR) values and 95% confidential intervals. The PTM group entered a glucocorticoid treatment trial. Patients with complete response were followed up to the first relapse in a cohort study. The relative risk (RR) values of the main risk factors were calculated for PTM relapse to test their etiological roles. Results: Among the 19 factors, six risk factors were identified: thyroid-stimulating hormone (TSH) receptor antibody (TRAb) (OR 42.93), autoimmune thyroid disease (AITD) or AITD history (OR 10.30), local trauma (OR 6.55), venous stasis posture (OR 6.16), cigarette smoking (OR 4.48), and age (OR 1.05). Serum TRAb levels were positively correlated with the severity of PTM. Of note, 371/400 patients received glucocorticoid treatment, and 330 achieved complete response. The serum TRAb levels after treatment decreased dramatically compared with those before treatment. After stopping glucocorticoid treatment, serum TRAb levels increased significantly when PTM relapsed (P < 0.001). In 165 relapse cases, an increase in serum TRAb levels occurred first, followed by persistent venous stasis posture or local trauma and finally PTM. The RR of elevated serum TRAb levels was 6.73 in PTM relapse cases. In the elevated serum TRAb level group, the RRs of local trauma, venous stasis posture, and local trauma plus venous stasis posture were 8.81, 6.5, and 8.84, respectively, for PTM relapse cases. Conclusions: TSHR autoimmunity and local factors in the six identified risk factors are the main causes of PTM occurrence.

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Section: Diagnosis and Treatmentmentioning

confidence: 99%

Thyroid-Stimulating Hormone Receptor Autoimmunity and Local Factors in Multiple Risk Factors Are Mainly Involved in the Occurrence of Pretibial Myxedema

Lan

Liao

et al. 2020

J Clin Med Res

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“…When dermatologic manifestations persist, specific therapy may become necessary. For example, studies have shown the efficacy of treating pretibial myxedema with intralesional corticosteroid injections; this treatment approach also applies to patients with similar findings secondary to hypothyroidism (13). Furthermore, treatments to combat hyperhidrosis include topical use of aluminum salts such as aluminum chloride and iontophoresis as firstline approaches.…”

Section: Treatmentmentioning

confidence: 99%

Dermatologic manifestations of endocrine disorders

Lause¹,

Kamboj²,

Faith³

2017

Transl. Pediatr

129

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The skin serves as a window for clinicians to understand, diagnose, and monitor endocrine disease. Dermatologic manifestations of endocrinopathies contribute significantly to an individual's health and quality of life. In this review, we outline various disorders of the hypothalamic-pituitary axis, thyroid gland, pancreas, adrenal gland, and androgen axis as well as hereditary endocrine syndromes. In acromegaly, glycosaminoglycan deposition contributes to a thickening of skin and soft tissue, which manifests as coarsening and enlargement of facial and acral structures. Stimulation of the thyrotropin receptor in hyperthyroidism results in mesenchymal tissue proliferation and consequent pretibial myxedema; other associated cutaneous features include onycholysis, and hyperhidrosis. Individuals with hypothyroidism exhibit cold, dry skin and brittle hair as well as a jaundice-like appearance due to carotene excess. The cutaneous features of diabetes mellitus (DM), mediated to a large extent by hyperglycemia and hyperinsulinemia, include necrobiosis lipoidica diabeticorum (NLD), diabetic dermopathy, and acanthosis nigricans. Pediatric patients with Cushing's syndrome almost invariably present with truncal obesity and growth retardation; disruption of collagen formation and the catabolic effects of hypercortisolism result in skin atrophy and purple abdominal striae. In patients with Addison's disease, generalized hyperpigmentation, secondary to elevated levels of melanocyte-stimulating hormone (MSH), is most prominent in sun-exposed areas. Due to hyperandrogenism, individuals with polycystic ovarian syndrome (PCOS) often exhibit hirsutism, acne vulgaris, and androgenetic alopecia. In multiple endocrine neoplasia (MEN) syndromes, specific gene mutations may lead to angiofibromas, lichen amyloidosis, and ganglioneuromas. Disruptions of immune regulation result in autoimmune polyglandular syndromes (APS) and associated clinical features including chronic mucocutaneous candidiasis, vitiligo, and alopecia areata. This paper highlights the underlying pathophysiology, dermatologic manifestations, and treatment of the aforementioned endocrine disorders.

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“…Local glucocorticoid application to PTM has been the most effective therapeutic option. Lan et al[ 9 ] have treated PTM using an intralesional glucocorticoid - triamcinolone acetonide acetate - at a concentration of 50 mg/5 mL and the total dose was no more than 100 mg at each session in a patient. Intralesional injection was once every 3 d (regimen 1) or once every 7 d (regimen 2) in PTM patients.…”

Section: Discussionmentioning

confidence: 99%

Intralesional and topical glucocorticoids for pretibial myxedema: A case report and review of literature

Zhang¹,

Lin²,

Chen³

et al. 2018

WJCC

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Pretibial myxedema (PTM), an uncommon manifestation of Graves’ disease (GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with PTM who achieved complete remission by multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application for a self-controlled study. A 53-year-old male presented with a history of GD for 3.5 years and a history of PTM for 1.5 years. Physical examination revealed slight exophthalmos, a diffusely enlarged thyroid gland, and PTM of both lower extremities. One milliliter of triamcinolone acetonide (40 mg) was mixed well with 9 mL of 2% lidocaine in a 10 mL syringe. Multipoint intralesional injections into the skin lesions of the right lower extremity were conducted with 0.5 mL of the premixed solution. A halometasone ointment was used once daily for PTM of the left lower extremity until the PTM had remitted completely. The patient’s PTM achieved complete remission in both legs after an approximately 5-mo period of therpy that included triamcinolone injections once a week for 8 wk and then once a month for 2 mo for the right lower extremity and halometasone ointment application once daily for 8 wk and then once 3-5 d for 2 mo for the left lower extremity. The total dosage of triamcinolone acetonide for the right leg was 200 mg. Our experience with this patient suggests that multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application are safe, effective, and convenient treatments. However, the topical application of a glucocorticoid ointment is a more convenient treatment for patients with PTM.

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A Randomized Controlled Trial of Intralesional Glucocorticoid for Treating Pretibial Myxedema

Cited by 15 publications

References 17 publications

Thyroid-Stimulating Hormone Receptor Autoimmunity and Local Factors in Multiple Risk Factors Are Mainly Involved in the Occurrence of Pretibial Myxedema

Thyroid-Stimulating Hormone Receptor Autoimmunity and Local Factors in Multiple Risk Factors Are Mainly Involved in the Occurrence of Pretibial Myxedema

Dermatologic manifestations of endocrine disorders

Intralesional and topical glucocorticoids for pretibial myxedema: A case report and review of literature

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