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[P427] A case of pretibial myxedema presented in the patient with hypothyroidism
( Hoo Min Choi ),( Suk Young Lee ),( Jong Baik Kim ),( Sung Min Kim ),( Eun Jung Ko ),( Byung In Ro ),( Han Kyoung Cho ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1
Pretibial myxedema is a form of diffuse mucinosis in which there is an accumulation of excess mucin (glycosaminoglycans) in the dermis and subcutis. It occurs mainly in patients with Graves` disease and rarely with Hashimoto thyroiditis, primary hypothyroidism. These patients characteristically have very high serum concentrations of thyroid-stimulating hormone (TSH) receptor antibodies. It occurs maily in women 40~60 years old. It is most commonly seen on the pretibial areas and is characterized by swelling, thickening, hardening of the lower legs. The involved skin may be violaceous or slightly pigmented (yellow-brown). Diagnosis is made by taking a history and finding characteristic clinical appearance of the skin lesion. Punch biopsy is rarely necessary but if done, it shows deposition of mucin throughout the dermis and subcutis. A 82-year-old woman had non-pitting nodules on both pretibial area and brownish edematous, thickened, hardened skin on from both pretibial area to dorsum of feet. She had no symptoms. She had been taking a levothyroxine 50μg tablet daily due to hypothyroidism. Her thyroid function test (TFT) showed hypothyroidism and high level of TSH receptor antibodies. Punch biopsy specimen showed markedly increased dermal mucin by Alcian blue stain. Herein, we report a case of pretibial myxedema presented in the patient with hypothyroidism.
[P044] A case of pretibial thyroid dermopathy
( Jeong Won Jo ),( Young Bin Shin ),( Hae Bong Jeong ),( Yun Sun Moon ),( Do Seon Jeong ),( Eui Chang Jung ),( Chi Yeon Kim ),( Tae Jin Yoon ) 대한피부과학회 2017 대한피부과학회 학술발표대회집 Vol.69 No.1
Pretibial myxedema(PM) is a dermatological manifestation of Graves` disease, which commonly presents as diffuse, non-pitting edema of shins and less often as plaques, nodules, or elephantiasis lesions mimicking lymphedema. Most common site is pretibial area and localized thickening of the pretibial skin causes deposition of acid mucopolysaccharides. There are 7 cases of pretibial myxedema reported in domestic dermatology literature. The only four of cases occurred after treatment of hyperthyroidism like that our case. Herein, we report a case of pretibial myxedema with Grave`s disease and Grave`s ophthalmopathy. A 51-year-old male visited our department with multiple erythematous patches and nodules on Lt. pretibial area. He had been diagnosed with Grave`s disease 6 months ago and Grave`s ophthalmopathy 3 months ago. The incisional biopsy on Lt. pretibial area showed mucinosis in dermis with perivascular lymphocytic infiltration. The lesions improved after steroid intralesional injection. For persisted local lesions despite improvement of systemic symptoms, we propose that the steroid intralesional injection may be an alternative to treatment.
홍석훈(Seok Hun Hong),이주협(Joo Hyeup Lee),서성준(Seong Jun Seo),홍창권(Chang Kwun Hong),노병인(Byung In Ro) 대한피부과학회 1992 대한피부과학회지 Vol.30 No.2
Pretibial myxedema, which consists of localized cutaneous accumulations of acid mucopolysaccharides, oceurs in a few patients with hyperthyroidi';m after its correction by surgery or radioactive iodine therapy. We report a case of pretibial myxedema with exophthalmos in a 36 year old male. He has suffered from hyperthyroidism with bilateral pretibial myxedema for a period of 4 years. He was treated with a subtotal thyroidectomy and excision of both pletibia lesions 1 year ago. The lesions recurred on t,he left pretibial area, as a 11 X 16cm sized, non pitting, non tender, swollen, brownish plaque. The histopathologic findings showed epidermal hyperkeratosis and a considerable arnount of mucin in the mid-dermis. We treat.ed him with intralesional injection of triamcinolone acetonide with marked improvement. (Kor J Dermetol 1992;30(2): 239-243)
황정열(Jung Yuel Hwang),김낙인(Nack In Kim),허충림(Choong Rim Haw) 대한피부과학회 1993 대한피부과학회지 Vol.31 No.3
We report a case of pretibial myxedema with hypothyroidism in a 52-year-old woman. She suffered from primary hypothyroidism for a period of 17 years. She was treated with a daily dose of sodium levothyroxine 0.2 mg intermittently. She had erythematous ftesh colored, hard and thickened plaque. on the left pretibial area for onr year. The histopathologic findings showed considerable amount of muci in the upper and mid dermis. Toluidine blue and alcian blue stain demonstrated an extensive deposition of dermal mucin. We treated her with a topical steroid and oral sodium levothyrcxire. (Kor J Dermatol 1993; 31(3): 408-411)
이학중,이상석,박성욱,왕한영 인제대학교 1997 仁濟醫學 Vol.18 No.4
전경골 점액수종은 경골 전면에 산성 점다당질이 과다 축적되는 대사 질환으로 압박시 함몰이 없는 적색 혹은 갈색의 부종성 판으로 나타나며, 대부분 그레이브스 병을 가진 환자에서 발생한다. 저자들은 임상 및 병리조직학적으로 전형적인 전경골 점액수종 2예를 경험하고 문헌 고찰과 함께 보고하는 바이다. We report two cases of pretibial myxedema associated with hyperthyroidism. Histopathologic findings of both cases shows considerable amount of mucin in upper and mid-dermis. Alcian blue staninig in pH 2.5 demonstrates extensive mucin deposition in dermis. The skin lesions of two cases has been improved by topical corticosteroid wish occlusive dressing technique.
A case of pretibial thyroid dermopathy improved with intralesional triamcinolone acetonide
( Jae Won Lee ),( Shinwon Hwang ),( Do Young Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.1
Pretibial myxedema(PTM) is a cutaneous manifestation of Graves’ disease, which commonly presents as painless nonpitting edema with a waxy, indurated texture. In addition to conventional treatment using topical steroids under occlusive dressing, there have been reports of intralesional application showing good results. We report a case of severe PTM which showed improvement with intralesional triamcinolone acetonide. A 61-year-old female with a history of Graves’ disease presented diffuse non-depressible edema and partially nodular changes on both shins with discomforts by skin tightness and neuropathic pain, which occurred 6 months ago. Histopathology from the lesion which showed typical mucin deposition in entire thickened dermis confirmed PTM. Multipoint injection of triamcinolone acetonide was administered and the patient showed improvement in each session. There was marked reduction of edema and skin hyperemia after 5 sessions of treatment. TSH receptors in the connective tissue may be the nonspecific antigen and the release of cytokines from T lymphocytes stimulates fibroblast to produce glycosaminoglycans(GAGs) in dermis. This case highlights the effectiveness of intralesional steroid injection for PTM, which may have anti-inflammatory effect and also down-regulate the synthesis of GAGs. The intralesional application seems to obtain a more compact and localized effect, while avoiding adverse effects of systemic administration.
이효진 ( Hyo Jin Lee ),김영식 ( Young Sik Kim ),신동훈 ( Dong Hoon Shin ),최종수 ( Jong Soo Choi ),김기홍 ( Ki Hong Kim ) 대한피부과학회 2011 대한피부과학회지 Vol.49 No.4
Pretibial myxedema (PTM) is a asymptomatic localized thickening of the pretibial skin due to deposition of acid mucopolysacharides (glycosaminoglycans). PTM, Graves` ophthalmopathy (GO) and thyroid acropachy are the triad of classic extrathyroidal manifestations of Graves` disease. PTM usually follows the onset of GO, and PTM develops after the diagnosis and treatment of hyperthyroidism. We report here on a 51-year-old female who presented with painful, well demarcated hyperpigmented plaques with nonpitting edema on both lower legs. The histopathologic findings showed an increased accumulation of mucin throughout dermis. In our patient, PTM was the earliest manifestation and this led to the diagnosis of Graves` disease. (Korean J Dermatol 2011;49(4):353∼356)