Obesity-Associated Lymphedematous Mucinosis: Two Further Cases and Review of the Literature

Abstract

Cutaneous mucinoses are a group of conditions characterized by increased amounts of acid mucin in the dermis. They can be generalized or localized and occur isolated or in the setting of systemic diseases. Obesity-associated lymphedematous mucinosis is a distinct variant of mucinosis occurring in obese patients without any thyroid dysfunction. So far, only few cases of this rare condition have been reported in the English literature. Here, we describe two new cases and discuss some histological differences with the pretibial myxedema.

New and emerging conditions of acquired cutaneous mucinoses in adults

“…OACM has a benign course causing mainly a cosmetic disfigurement. Strong dietary restriction for weight reduction is the mainstay of management 4 . Pressure bandages with gradual compression has been recommended for improving lymphostasis and venous insufficiency 4 .…”

“…Strong dietary restriction for weight reduction is the mainstay of management 4 . Pressure bandages with gradual compression has been recommended for improving lymphostasis and venous insufficiency 4 . When vascular insufficiency is severe, a surgical procedure can be considered 5–6 …”

“…Subsequently, increased mucin deposition has been described in obese patients with lymphedema of the legs. 4 Clinical and histopathological features The clinical manifestations of obesity-associated cutaneous mucinosis (OACM) are characterized by asymptomatic, skin-colored to erythematousyellowish semi-translucent papules and nodules arising on the legs being associated with erythema, edema, and lymphostasis on the pretibial areas in a bilateral way (Fig. 2a).…”

“…The thighs, foot, or ankles are rarely involved. 4 Occasionally, when lymphedema is marked, vesicles may develop. Stasis mucinosis may present with blue-purple, smooth, pebbly, and partially blanchable nodules and plaques, sometimes painful associated with signs of chronic venous insufficiency on the pretibial area.…”

Insidious-Onset Indurated Plaques on the Shins

“…Can mimic pretibial myxedema but is classically associated with obesity; thyroid disorder is absent [21]. Typical skin-colored-to-yellowish papules, plaques and nodules arise in the pretibial region of lymphedematous legs [22].…”