Successful therapeutic approach in a patient with elephantiasic pretibial myxedema

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.

Keywords: Evaluation of results of therapeutic interventions; Myxedema; Steroids; Therapeutics.

Figure 1

Clinical aspect of the right foot and ankle: confluent brownish nodules on waxy plaque. Hypertrichosis and hyperpigmentation are noted. First session of intralesional application of corticosteroid.

Figure 2

Clinical appearance of the right foot and ankle at the first session of intralesional application of corticosteroid. Non-depressible edema associated with hyperpigmentation reaching the lower third of the right limb, including lateral and posterior portions.

Figure 3

Important spacing of the collagen bundles of the upper reticular dermis, slight increase in the number of fibroblasts. Abundant deposit of mucin (arrow) (Hematoxylin & eosin, ×200) (Alcian blue, ×400).

Figure 4

Clinical appearance of the right foot and ankle after 11 months of intralesional corticosteroid therapy. Almost total reduction of nodules and edema, making the appearance resemble the contralateral foot.

Figure 5

Clinical appearance of the right foot and ankle after 11 months of treatment with intralesional corticosteroid therapy. An important reduction of nodules and cutaneous texture is observed.