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Insidious-Onset Indurated Plaques on the Shins
Rishi Agrawal1, Daniel Knabel2,3, Anthony P Fernandez2,3
1Imperial College School of Medicine, Imperial College London, South Kensington, London SW7 2BU, UK.
Abstract:
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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