Pre-tibial myxedema: treatment with intralesional corticosteroid

Ramos, Luana Oliveira; Mattos, Paloma Corrêa; Figueredo, Giuseppe Lemos Pertoti de; Maia, Alef Alioscha Andrade; Romero, Sandra Adolfina Reyes

doi:10.1590/abd1806-4841.20153651

Cited by 10 publications

(5 citation statements)

References 8 publications

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“…The treatment of choice is topical application of a mid- or high-strength glucocorticoid under occlusion to improve absorption [ 7 , 8 , 9 ]. Pentoxifylline [ 10 , 11 ], intralesional injections of hyaluronidase with [ 12 ] or without [ 13 , 14 ] intralesional injections of glucocorticoid, rituximab [ 15 ], IVIG [ 16 ] and UVA-1 phototherapy [ 17 ] have all been reported with varying degrees of success.…”

Section: Discussionmentioning

confidence: 99%

Insidious-Onset Indurated Plaques on the Shins

2021

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A 64-year old male presented with a several-year history of an insidious-onset tender, itchy and xerotic rash on his lower legs. Past medical history was significant for Graves’ disease and Graves’ ophthalmopathy. The examination revealed peau d’orange-appearing plaques on his shins clinically consistent with pretibial myxedema. A punch biopsy showed separation of collagen bundles with extensive dermal mucin deposition, confirming the diagnosis of pretibial myxedema. After initially failing treatment with a topical clobetasol 0.05% ointment, the patient switched to regular pentoxifylline and triamcinolone 0.1% ointment under occlusion. He remains under follow-up.

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Section: Discussionmentioning

confidence: 99%

Insidious-Onset Indurated Plaques on the Shins

2021

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“…The pathogenesis of PTM is unclear but there appears to be interactions of immunologic, cellular, and mechanical processes. TSH receptors in fibroblasts can be attacked by TRAbs, inducing immune activation that is mediated by T lymphocytes[ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…They considered that compound betamethasone with multipoint intralesional injection is a feasible, effective, and secure novel strategy in the treatment of PTM. However, we cannot evaluate the precise difference in the effects of local glucocorticoids among the different administration routes because of different clinical phenotypes, doses, and frequencies of glucocorticoid in the articles related to treatment for PTM[ 8 - 11 , 14 , 15 , 17 ].…”

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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“…As to outcome of PTM, generally accepted view was that it was self-limited and lesions usually resolved spontaneously without requirement of therapy [ 7 , 8 ]. This view was contradicted to the clinical reality.…”

Section: Discussionmentioning

confidence: 99%

Morphological Diversity of Pretibial Myxedema and Its Mechanism of Evolving Process and Outcome: A Retrospective Study of 216 Cases

Lan

Wang

Zeng

et al. 2016

Journal of Thyroid Research

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Background. Pretibial myxedema (PTM) is a rare dermopathy. The morphologic features and mechanism of its evolving process are not reported in large case series. Methods. 216 cases with PTM were retrospectively reviewed to analyze demographics, history, lesional morphology and its evolving process, histopathology and immunohistochemistry, serum TRAb levels, treatment, and outcome. Results. First appearing lesions evolved into 6 variants that were correlated with serum TRAb levels. Subvariants were caused by different kinds and frequencies of local trauma. The evolving process could be classified into 4 stages that were correlated with serum TRAb levels and perivascular infiltration of CD8+ and CD4+ lymphocytes. Serum TRAb levels at remission and in nonrecurred cases became lower than those before therapy and in recurred cases, respectively, but increased when PTM relapsed. TRAb level in nodule variant went down invariably with the extension of course and its autoimmune activity had a trend to stop but in other 5 variants TRAb levels fluctuated. Their autoimmune activities had no trends to stop and clinically worsen through intermittent repeats of active and stable stages. Conclusions. In the chronic course of PTM, nodule variant is self-limited and other 5 variants are not self-limited. PTM needed early treatment to avoid severe variants.

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Pre-tibial myxedema: treatment with intralesional corticosteroid

Cited by 10 publications

References 8 publications

Insidious-Onset Indurated Plaques on the Shins

Insidious-Onset Indurated Plaques on the Shins

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

Morphological Diversity of Pretibial Myxedema and Its Mechanism of Evolving Process and Outcome: A Retrospective Study of 216 Cases

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