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Dauguet M, Abba S, Lebrun-Vignes B, Vignes S. Des lésions végétantes des jambes. Rev Med Interne 2022; 43:450-451. [DOI: 10.1016/j.revmed.2022.03.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 10/18/2022]
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Endo M, Yamamoto T. Natural course of pretibial myxedema after a 14-year interval. Int J Dermatol 2020; 60:e24-e25. [PMID: 32614072 DOI: 10.1111/ijd.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 06/05/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Mai Endo
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
| | - Toshiyuki Yamamoto
- Department of Dermatology, Fukushima Medical University, Fukushima, Japan
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Ferreira M, Zacaron LH, Valle AFD, Gamonal ACC. Successful therapeutic approach in a patient with elephantiasic pretibial myxedema. An Bras Dermatol 2020; 95:469-472. [PMID: 32461007 PMCID: PMC7335876 DOI: 10.1016/j.abd.2019.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 02/11/2019] [Indexed: 11/02/2022] Open
Abstract
Localized pretibial myxedema is a dermopathy whose treatment is a challenge in dermatology, occurring in 0.5–4% of patients with Graves’ disease. This autoimmune thyroid condition stimulates the production of hyaluronic acid and glycosaminoglycans that are deposited particularly in the pretibial region. Clinically, it presents as a localized, circumscribed, and non-depressible infiltrate in plaques. Several treatment modalities have been proposed, and their results vary, with worse response observed in severe cases. This report presents the case of a patient with elephantiasic pretibial myxedema who was subjected to intralesional corticosteroid applications, resulting in an excellent and encouraging therapeutic response that was maintained.
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Lee JH, Park SM, Lew BL, Sim WY. Pretibial Myxedema Presenting as Severe Elephantiasis. Ann Dermatol 2018; 30:592-596. [PMID: 33911484 PMCID: PMC7992468 DOI: 10.5021/ad.2018.30.5.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 09/07/2017] [Accepted: 09/12/2017] [Indexed: 11/16/2022] Open
Abstract
Elephantiasis is a symptom characterized by the thickening of the skin and underlying tissues in the legs. Pretibial myxedema (PTM) is a non-frequent manifestation of autoimmune thyroiditis, particularly Graves' disease. Lesions of myxedema occur most commonly on the pretibial surfaces, also develop at sites of previous injury or scars and other areas. A 49-year-old male presented with severe elephantiasis on the both pretibial areas, dorsum of the feet, ankles and toes. Twenty years previously, he had received radioactive iodine treatment for thyrotoxicosis. Laboratory tests showed that the patient's thyroid function was normal, but the level of thyroid stimulating hormone (TSH) receptor antibodies was very high (>40 IU/L). The biopsy confirmed PTM. Interestingly, the connective tissue was stained with the TSH receptor antibodies in the deep dermis. Elephantiasic PTM is a severe form of the myxedema and there is few reported case. We report a rare case of PTM with appearance of severe elephantiasis.
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Affiliation(s)
- Jae-Hoon Lee
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Sang-Myung Park
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Bark-Lynn Lew
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Woo-Young Sim
- Department of Dermatology, College of Medicine, Kyung Hee University, Seoul, Korea
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Ren Z, He M, Deng F, Chen Y, Chai L, Chen B, Deng W. Treatment of pretibial myxedema with intralesional immunomodulating therapy. Ther Clin Risk Manag 2017; 13:1189-1194. [PMID: 28932121 PMCID: PMC5598751 DOI: 10.2147/tcrm.s143711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective Local immune regulation therapy has been one of the therapeutic methods used for the treatment of autoimmune thyroid disease in patients with pretibial myxedema (PTM). However, the poor response rate and high recurrence rate are still major problems. Whether a premixed corticosteroid, compound betamethasone, could enhance remission rate and decrease recurrence rate in patients with PTM was investigated in the present study. Subjects and methods We have performed a clinical utility observation of compound betamethasone with intralesional injections based on basic thyroid disease treatment in 32 PTM patients between January 2008 and August 2016. The patients were followed up for 2 years, and the clinical outcomes and side effects were calculated and analyzed. Results All patients had a complete remission after different times of injection. A total of 21.7% patients had complete remission with one time of injection, 34.8% with two times of injection, 17.4% with three times of injection, 4.3% with four times of injection, and 4.3% with five times of injection. In all, 56.3% patients with a disease duration of <6 months had complete remission after a 1-month treatment, 37.5% patients with a disease duration between 6 months and 12 months had complete remission after a 2-month treatment, 3.1% patients with a disease duration of 2 years had complete remission after a 5-month treatment, and 3.1% with a disease duration of 5 years had complete remission after a 7-month treatment. Conclusion Compound betamethasone with multipoint intralesional injection is a feasible, effective, and secure novel strategy in the treatment of PTM.
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Affiliation(s)
- Ziwei Ren
- Department of Endocrinology and Nephrology, Chongqing Emergency Medical Hospital (The Fourth People's Hospital of Chongqing)
| | - Min He
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Fang Deng
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Yan Chen
- Department of Endocrinology and Nephrology, Chongqing Emergency Medical Hospital (The Fourth People's Hospital of Chongqing)
| | - Liyin Chai
- Department of Endocrinology and Nephrology, Chongqing Emergency Medical Hospital (The Fourth People's Hospital of Chongqing)
| | - Bing Chen
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China
| | - Wuquan Deng
- Department of Endocrinology and Nephrology, Chongqing Emergency Medical Hospital (The Fourth People's Hospital of Chongqing)
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Shirai K, Ito T, Mitsuhashi Y, Tsuboi R. Dramatic effect of low-dose oral steroid on elephantiasic pretibial myxedema. J Dermatol 2014; 41:941-2. [PMID: 25200964 DOI: 10.1111/1346-8138.12608] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Kohei Shirai
- Department of Dermatology, Tokyo Medical University, Tokyo, Japan
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Bartalena L, Fatourechi V. Extrathyroidal manifestations of Graves' disease: a 2014 update. J Endocrinol Invest 2014; 37:691-700. [PMID: 24913238 DOI: 10.1007/s40618-014-0097-2] [Citation(s) in RCA: 149] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 05/20/2014] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Graves' orbitopathy (GO), thyroid dermopathy (also called pretibial myxedema) and acropachy are the extrathyroidal manifestations of Graves' disease. They occur in 25, 1.5, and 0.3 % of Graves' patients, respectively. Thus, GO is the main and most common extrathyroidal manifestation. Dermopathy is usually present if the patient is also affected with GO. The very rare acropachy occurs only in patients who also have dermopathy. GO and dermopathy have an autoimmune origin and are probably triggered by autoimmunity to the TSH receptor and, likely, the IGF-1 receptor. Both GO and dermopathy may be mild to severe. MANAGEMENT Mild GO usually does not require any treatment except for local measures and preventive actions (especially refraining from smoking). Currently, moderate-to-severe and active GO is best treated by systemic glucocorticoids, but response to treatment is not optimal in many instances, and retreatments and use of other modalities (glucocorticoids, orbital radiotherapy, cyclosporine) and, in the end, rehabilitative surgery are often needed. Dermopathy is usually managed by local glucocorticoid treatment. No specific treatment is available for acropachy. PERSPECTIVES Novel treatments are presently being investigated for GO, and particular attention is paid to the use of rituximab. It is unknown whether novel treatments for GO might be useful for the other extrathyroidal manifestations. Future novel therapies shown to be beneficial for GO in randomized studies may be empirically used for dermopathy and acropachy.
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Affiliation(s)
- Luigi Bartalena
- Department of Clinical and Experimental Medicine, University of Insubria, Endocrine Unit, Ospedale di Circolo, Viale Borri, 57, 21100, Varese, Italy.
| | - Vahab Fatourechi
- Department of Endocrinology and Metabolism, Mayo Clinic, Rochester, MN, USA.
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Kim WB, Mistry N, Alavi A, Sibbald C, Sibbald RG. Pretibial Myxedema: Case Presentation and Review of Treatment Options. INT J LOW EXTR WOUND 2014; 13:152-154. [PMID: 24807996 DOI: 10.1177/1534734614531485] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Pretibial myxedema (PM) is a rare autoimmune manifestation of Graves' disease, which commonly presents as diffuse, nonpitting edema of shins and less often as plaques, nodules, or elephantiasis lesions mimicking lymphedema. We present a 57-year-old woman with 12-month history of PM, which occurred a year after treatment of Graves' disease and improved with topical corticosteroids, support stockings, and intralesional steroid injections until recurrence with local erythema and woody edema. A literature review was undertaken of the evidence-based treatment modalities for symptomatic PM: although commonly asymptomatic and self-limited, severe cases of PM may be treated with topical corticosteroid, compressive therapy, and intralesional corticosteroid injections.
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Affiliation(s)
- Whan B Kim
- McMaster University, Hamilton, Ontario, Canada
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Abstract
Graves' disease is an autoimmune condition commonly associated with thyroid dysfunction and with anti-thyroid antibodies, usually TSH receptor stimulating antibodies. Thyroid autoimmunity also may be associated with extra thyroidal manifestations. Most common extra thyroidal manifestation is ophthalmopathy. Less common is thyroid dermopathy, usually occurring in pretibial area. Dermopathy is almost always associated with ophthalmopathy and in severe cases with acropachy. A common antigen with thyroid in tissues of the skin and the eyes, most likely TSH receptor, is involved in pathogenesis of extra thyroidal manifestations. Presence of dermopathy and acropachy are predictors of severity of autoimmune process. Local corticosteroid application is the standard therapy for dermopathy. Response to therapy is good in mild cases and poor in severe cases. Immune modulators and biotherapies are undergoing randomized trials for ophthalmopathy component of Graves' disease. Any therapy proven to be effective for ophthalmopathy can be utilized in future for management of dermopathy.
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Affiliation(s)
- Vahab Fatourechi
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, 200 First ST SW, Rochester, MN, USA.
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A Triad of Exophtalmos, Pretibial Myxedema and Acropachy in a Patient With Graves’ Disease / Egzoftalmus, pretibijalni miksedem i akropatija − trijada prisutna kod obolelog od Grejsove bolesti. SERBIAN JOURNAL OF DERMATOLOGY AND VENEREOLOGY 2012. [DOI: 10.2478/v10249-012-0008-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract
A classical triad of extrathyroidal manifestations of Graves’ disease known as EMO syndrome (exophthalmos, pretibial myxedema and osteoarthropathy) is a rare condition. This paper presents a 39-year old male patient who underwent chemo- and radiation therapy of the supradiaphragmatic area due to Hodgkin’s disease at the age of 35 and 36 leading to remission. Two years later, the patient developed general symptoms of Graves’ disease and ophthalmopathy, with high thyroid stimulating hormone levels. Four months later, the patient presented with pretibial myxedema. Thirteen months after the onset of the disease, higher levels of thyroxine and decreased levels of thyroid stimulating hormone were registered. The diagnosis of EMO syndrome was confirmed by radiologic and histopathological analyses. Thiamazole and intralesional corticosteroid therapy were administered, resulting in euthyreosis and decrease of pretibial myxedema. The question is whether the autoimmune thyroid disease was triggered by the previous disease, or by chemo- and radiation therapy..
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Madaj P, McPhaul L, Gianoukakis AG. Elephantiatic dermopathy. Int J Dermatol 2012; 52:987-9. [PMID: 22417118 DOI: 10.1111/j.1365-4632.2011.05275.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Paul Madaj
- Division of Endocrinology, Department of Pathology, Harbor-UCLA Medical Center and the David Geffen School of Medicine at the University of California-Los Angeles, CA, USA
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Elephantiasic thyroid dermopathy. Am J Med 2011; 124:e1-2. [PMID: 21497784 DOI: 10.1016/j.amjmed.2011.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 02/21/2011] [Accepted: 02/23/2011] [Indexed: 11/24/2022]
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Thyroid dermopathy localized to areas of injury and responsive to complete decongestive physiotherapy. J Am Acad Dermatol 2011; 64:1219-20. [DOI: 10.1016/j.jaad.2009.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2009] [Revised: 11/03/2009] [Accepted: 11/13/2009] [Indexed: 11/17/2022]
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Mishriki YY. Puzzles in Practice. Postgrad Med 2010; 122:162-4. [DOI: 10.3810/pgm.2010.03.2134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Chatterjee S, Karai LJ. Elephantiasis nostras verrucosa in a patient with systemic sclerosis. Clin Exp Dermatol 2009; 34:e696-8. [PMID: 20055839 DOI: 10.1111/j.1365-2230.2009.03432.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Elephantiasis nostras verrucosa (ENV) is an unusual skin condition characterized by dermal fibrosis and hyperkeratotic verrucous lesions resulting from chronic nonfilarial lymphoedema. The condition is similar to 'elephantiasis tropica', in which elephantiasis develops secondary to filariasis. Lymphatic obstruction can be primary or due to various causes such as surgery, tumour, radiation, congestive heart failure or obesity. Recurrent attacks of cellulitis lead to further impairment of lymphatic drainage, causing permanent swelling, dermal fibrosis and epidermal thickening. We report a case of a 56-year-old man with systemic sclerosis (SS), who presented with painful lesions on both legs, consistent with ENV. He developed extensive, fungating, papillomatous lesions on the skin of the legs, toes and dorsa of the feet over a period of 3 years. Histology revealed dense dermal fibrosis, oedema of the papillary dermis and extensive pseudo-epitheliomatous changes. To our knowledge, this is the first report of ENV in which SS was considered to be the primary cause for the impairment of lymphatic flow.
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Affiliation(s)
- S Chatterjee
- Department of Rheumatic and Immunologic Diseases, The Cleveland Clinic, 9500 Euclid Avenue/Desk A50, Cleveland, OH 44195, USA.
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Castiñeiras I, del Pozo J, Robles O, Martínez-González C, Fernández-Torres R, Fonseca E. Euthyroid nodular pretibial mucinosis: palliative treatment with carbon dioxide laser. Dermatol Surg 2009; 35:719-21. [PMID: 19400889 DOI: 10.1111/j.1524-4725.2009.01115.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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