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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.
Dermatopathology (Basel, Switzerland)
|July 2, 2021
Summary
This case study details a 64-year-old male with Graves' disease experiencing pretibial myxedema. Effective treatment involved pentoxifylline and triamcinolone ointment, improving the skin condition.
Area of Science:
- Dermatology
- Endocrinology
Background:
- Graves' disease is an autoimmune disorder that can lead to various complications.
- Graves' ophthalmopathy is a common manifestation of Graves' disease.
Observation:
- A 64-year-old male presented with a chronic, itchy, and dry rash on his lower legs.
- Clinical examination revealed peau d'orange plaques on the shins, suggestive of pretibial myxedema.
- The patient had a history of Graves' disease and Graves' ophthalmopathy.
Findings:
- Punch biopsy confirmed pretibial myxedema through collagen bundle separation and dermal mucin deposition.
- Initial treatment with topical clobetasol 0.05% ointment was ineffective.
- A switch to regular pentoxifylline and triamcinolone 0.1% ointment under occlusion led to improvement.
Implications:
- This case highlights the importance of recognizing pretibial myxedema in patients with Graves' disease.
- It suggests that a combination therapy of pentoxifylline and topical corticosteroids may be effective for managing recalcitrant cases.
- Further research into optimal treatment strategies for pretibial myxedema is warranted.
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