Midfacial involvement in lichen myxedematosus: a clinical pearl in diagnosis

Lichen myxedematosus: toward established classification and diagnostic criteria

“…We have previously suggested two sets of diagnostic criteria for LM; the first set comprises constant clinical and histopathological features that are always present in every case and are necessary for the diagnosis of this rare disorder, and the second set includes associated features that were variably reported in some patients and to which any emerging finding can be added . We agree with the author that the midfacial cutaneous involvement recently proposed by Baykal and Yazganoglu helps to differentiate the cutaneous lesions of LM from scleredema and scleroderma; however, we do not agree to add this specific presentation to the constant features of our proposed diagnostic criteria because it can be included under the constant clinical criterion of “firm, waxy, closely set papules that may coalesce into indurated nodules or plaques” that could easily encompass any clinical presentation such as discrete, acral persistent, self‐healing subtypes, and the midfacial presentation. This helps to avoid confusion that may result from the addition of many subclinical presentations to a simplified diagnostic criterion.…”

Lichen myxedematosus: suggestions on the newly proposed diagnostic criteria

“…It is almost always associated with paraproteinemia . Interestingly, Baykal and Yazganoglu have emphasized a midfacial cutaneous involvement in seven LM patients to distinguish (SM) from scleredema and scleroderma. They proposed three patterns; (i) Linear glabellar nodule; a linear‐shaped vertical nodular lesion on the glabella, with deep furrowing on the sides of this nodule and sparing of the nose, (ii) Midfacial plaque; bilateral linear plaques involving medial parts of the eyebrows, confluent on the glabella and extending to the nasal root, and (iii) Nasal nodule; a raised, round nodular lesion on the nasal root with spared glabella and the eyebrows.…”