clobetasol and Myxedema

Pretibial myxedema (PTM) is a rare manifestation of Graves' disease. There is paucity of data regarding long-term follow-up and response to treatment in PTM.. Retrospective study wherein 30 patients of PTM presenting during 2001-2011 attending dermatology and endocrinology outpatient departments were analyzed.. Among 30 patients with PTM, 12 were males and 18 females with a ratio of 1 : 1.5 males/females. Four morphological forms were identified: plaques (18 patients), diffuse non-pitting edema of both lower legs (five), nodules (five), and elephantiasis lesions (two). Eighty percent were diagnosed with hyperthyroidism before the development of dermopathy. Twenty-six patients presented with ophthalmopathy. Fourteen patients with plaque had an excellent response to topical clobetasol propionate ointment and attained complete resolution by 3.6 years. Out of 16 patients treated with combination therapy, which included nine treated with topical corticosteroids/intralesional triamcinolone and seven treated with oral, intralesional, and topical corticosteroids, nine attained complete resolution in the lesions by 3.4 years, and none relapsed anytime during four years of post-treatment follow-up. However, the remaining patients (elephantiasis and diffuse forms) failed to achieve complete resolution.. Plaques and nodules are common variants with a favorable clinical response to topical and intralesional corticosteroid; elephantine and diffuse forms responded poorly to therapy. Studies analyzing larger cohorts of patients with PTM and their long-term follow-up are limited, hence more such studies are required.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Aged; Clobetasol; Drug Therapy, Combination; Elephantiasis; Female; Follow-Up Studies; Glucocorticoids; Graves Ophthalmopathy; Humans; India; Injections, Intralesional; Leg Dermatoses; Male; Middle Aged; Myxedema; Ointments; Prednisolone; Retrospective Studies; Tertiary Care Centers; Thyrotropin; Thyroxine; Time Factors; Treatment Outcome; Triamcinolone; Triiodothyronine

Localized or pretibial myxedema is one of the signs of Graves disease (along with goiter, exophthalmus, thyroid acropathy, and high circulating levels of long-acting thyroid-stimulating hormone) and usually tends to occur at a later stage of the disease or even after the patient becomes euthyroid post treatment. Very rarely has it been reported in euthyroid patients. We report a euthyroid man presenting with localized myxedema on the extensor surface of his forearm with clinical and histopathological features consistent with pretibial myxedema. He responded partially to topical clobetasol propionate cream and tacrolimus ointment 0.1 percent for about 7 months. To the best of our knowledge, this is the first case of preradial myxedema in a euthyroid patient in the English international dermatological literature.

Topics: Aged; Anti-Inflammatory Agents; Biopsy; Clobetasol; Diagnostic Errors; Forearm; Humans; Hyperthyroidism; Immunosuppressive Agents; Leprosy; Male; Mucins; Myxedema; Skin; Tacrolimus; Thyroid Hormones

Topics: Administration, Oral; Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Female; Graves Disease; Humans; Middle Aged; Myxedema; Ointments; Pentoxifylline; Phosphodiesterase Inhibitors; Tibia

Topics: Administration, Topical; Anti-Inflammatory Agents; Clobetasol; Foot Diseases; Glucocorticoids; Graves Disease; Humans; Male; Middle Aged; Myxedema; Toes