Histologic confirmation was obtained by punch biopsy specimens and hematoxylin and eosin and alcian blue-periodic acid-Schiff staining in 62.3% of the patients. Last updated on Jul 3, 2020. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. A single copy of these materials may be reprinted for noncommercial personal use only. 4). Clinical correlation of pretibial myxedema with malignant exophthalmos. Baseline characteristics of the treated and untreated groups were different in the frequency of extreme forms of dermopathy, such as the elephantiasic form, which was present only in the treated group. Eye status was defined as normal, mild, moderate, and severe ophthalmopathy and ophthalmopathy associated with optic neuropathy (8, 9). We retrospectively reviewed the records of all patients who had a discharge diagnosis of thyroid dermopathy or PTM between January 29, 1969, and November 15, 1995, at the Mayo Clinic. Schermer et al. Intake of beta blockers to decrease or block the adverse effects of elevated thyroid hormone levels. 1 )]. The majority had therapy for less than 1.5 yr; however, one patient reported using continuous local therapy for 2.3 yr and another for 8 yr. Of the 96 patients who received topical corticosteroid treatments, 50 (52.1%) had no or minimal improvement at last known follow-up (17 have since died), 26 (27.1%) had moderate improvement (six have since died), and 20 (20.8%) had complete remission (three have since died). Stimulation of fibroblast biosynthetic activity by serum of patients with pretibial myxedema. Pretibial myxedema is almost always preceded by the ocular signs found in Graves' disease. In 81.0% of those treated by topical corticosteroids, the agents were applied under occlusion. 3). In a multivariate logistic regression with a stepwise selection procedure, no predictor entered the model at the P = 0.05 level of significance. Should Graves’ disease be considered a collagen disorder of the thyroid, skeletal muscle and connective tissue? Three years earlier, he had received a diagnosis of Graves’ disease with thyroid-associated ophthalmopathy and dermopathy. The patients were asked whether their thyroid-related skin condition had returned entirely to normal (complete remission) or almost normal (mild improvement or partial remission), was unchanged, or was worse (no improvement). Patients who did not receive therapy experienced a significantly (P = 0.03) higher rate of complete remission (34.7%) than those who received local therapy (18.7%), although the combined complete and partial remission rates were not significantly different for the treated and untreated groups (P = 0.3). Compression was used in some patients and consisted of athletic wraps or compression stockings, providing 20–40 mm Hg pressure. In some cases the cream was applied three times daily. Graves' dermopathy. The lesions were occasionally indurated and the hair follicles prominent so that the lesions had an orange peel (peau d’orange) or pig skin appearance and texture. Cases have been reported involving the shoulders, upper back, upper extremities, and pinnae (22). C, Nodular form in ankle and foot. Increased urinary excretion of acidic mucopolysaccharides in exophthalmos. The dermopathy of Graves' disease is a rare, painless, reddish lumpy skin rash that of Graves' disease is an autoimmune process. Topical treatment was initiated in the dermatology department, usually after histologic confirmation. A biopsy of the affected skin reveals mucin in the mid- to lower- dermis. Classic histopathologic features were seen, consisting of normal collagen in the papillary dermis and separation of the collagen bundles by mucin. The odds ratio (OR) and 95% confidence interval for the OR were computed. It forms the third component of the classical triad of Graves' disease (goiter, ophthalmopathy, pretibial myxedema). Photo Source: www.diabetesselfcaring.com. is a student at Mayo Medical School. The applied treatment was nighttime dressing of 0.05% to 0.1% triamcinolone acetate in cream base under occlusion with plastic film (Saran Wrap, Dow Chemical Co.). The focus of this paper is the 178 patients with a new diagnosis in the study period. Thirty-one cases of acropachy were diagnosed (17.4%). In fact, the untreated patients with 17 yr of follow-up had a 50% complete remission rate (Fig. E, Occurrence of thyroid dermopathy in scar tissue. (15) suggested that the stasis of venous blood and the daily physical trauma to the lower extremities might stimulate mucin deposition. Our general interest e-newsletter keeps you up to date on a wide variety of health topics. Commonly localized in the pretibial area, it is therefore often referred to as pretibial myxedema (PTM). 4), whereas the rate for the treated group was 50%. Baseline clinical characteristics of patients who received therapy for dermopathy at any time compared with patients who never received therapy. For these patients, local corticosteroid therapy under occlusion may offer additional help. In a multivariate logistic regression analysis using a stepwise selection procedure, the only predictor of improved outcome in the treatment group was a history of transantral orbital decompression and eye muscle surgery for ophthalmopathy (Table 4). The thyroid hormones are responsible for management of varied bodily functions such as regulation of metabolism, body temperature, muscle strength, nervous system and heart functioning, and menstrual cycles, etc. Graves’ ophthalmopathy can be corrected via ocular surgeries or use of prism-glasses, while its symptoms can be alleviated by corticosteroid medications. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Observations on the long-acting thyroid stimulator. ©1996-2020 MedicineNet, Inc. All rights reserved. The use of intralesional steroid injections is losing favor, despite a few favorable reports (6, 7), because of their tendency to cause lumpy-appearing skin and the frequent recurrence of disease after treatment (2, 7). Detection, cellular localization, and modulation of heat shock proteins in cultured fibroblasts from patients with extrathyroidal manifestations of Graves’ disease. Only 6.2% of patients in our study received corticosteroid injections; their remission rate was 27.3%, greater than that for patients receiving topical corticosteroids or compressive dressings. There was no statistically significant difference in complete plus partial remission rate between the local therapy and the no-therapy groups. High-dose iv immunoglobulin treatment (32) and plasmapheresis (33, 34) have also been used to treat PTM in a few patients and have led to improvement or remission of the condition (33). Twenty-one patients (11.8%) received compressive dressing treatment. After having received the initial treatment only, 16 patients (16.7%) had no or minimal improvement and 20 (20.8%) had moderate improvement on subsequent short-term follow-up examination. Forty-three patients (24.2%) had moderate improvement but not complete remission at last known follow-up (nine have since died). Of 195 patients seen at the Mayo Clinic for PTM during this period, 178 were diagnosed for the first time at the Mayo Clinic between 1969 and 1995. Application of petroleum jelly on the affected area could relieve the burning sensation and the itching. Echographic diagnosis of pretibial myxedema in patients with autoimmune thyroid disease. A diagnosis of PTM in the absence of ophthalmopathy is always questionable. Graves' dermopathy results from a buildup of certain carbohydrates in the skin — the cause of which isn't known. Though the causes of dermopathy are debated, its development follows a predictable pattern. Patients seen before 1989, who were subjects of a previous report (1), are included in the present study. They were also asked whether they had received any treatment for PTM (local corticosteroid cream, oral corticosteroid, cosmetic surgery, or other) since their last visit to the Mayo Clinic. Only five patients (3%) did not have any clinical evidence or history of ophthalmopathy. Forty-six patients (25.8%) had complete remission, with an average time to complete remission of 8.8 yr (range 0.3–30.4 yr). There is no increase in fibroblasts. We specifically present data on long-term outcome of mild, untreated and severe, treated groups in this disorder after analysis of the information obtained from the last clinical evaluation and the response of the patients to questionnaires mailed in September 2000. A review of the literature and case report. "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic. It is known by various other names like “Advanced hypothyroidism” and “Graves’ Dermopathy”. In this study, we report on the outcomes of 178 patients seen at our institution between January 1969 and November 1995 with thyroid dermopathy who were followed up for an average of 7.9 yr. Nonpitting edema was the most prevalent form of dermopathy (43.3%), and the pretibial area was the region most commonly involved (99.4%). LOCALIZED MYXEDEMA, OR thyroid dermopathy, is an infrequent manifestation of autoimmune thyroiditis and, in particular, of Graves’ disease. The treated and untreated groups were not comparable. The clinical form of PTM was nonpitting edema in 77 (43.3%), plaque in 48 (27.0%), nodular in 33 (18.5%), elephantiasic in 5 (2.8%), and unclassifiable and/or unknown in 15 (8.4%). Ideally, compression consists of athletic wraps or compression stockings, providing 20–40 mm Hg pressure. Klaus Wolff, Richard Allen Johnson, Dick Suurmond Treatment of Graves’ disease involves controlling the production of thyroid hormones, reducing the severity of symptoms, and managing any complications that may arise. Subscribe to Drugs.com newsletters for the latest medication news, alerts, new drug approvals and more. Topical corticosteroids have had their absorption further enhanced with hydrocolloid (25) or plastic wrap occlusive dressings. Pretibial myxedema has several typical clinical appearances. Copyright © 2002 by The Endocrine Society, EGFR/ErbB2 targeting lapatinib therapy for aggressive prolactinomas, Predictors Vertebral Deformity In Long-Term Survivors Of Childhood Acute Lymphoblastic Leukemia: The Petale Study, Multiple endocrine deficiencies are common in Hypoparathyroidism-Retardation-Dysmorphism (HRD) Syndrome, Bone mineral density and bone turnover after sleeve gastrectomy and gastric bypass, a randomized controlled trial, Effects of a tailored exercise intervention in acutely hospitalized diabetic oldest old adults: an ancillary analysis, The Journal of Clinical Endocrinology & Metabolism, About The Journal of Clinical Endocrinology & Metabolism, Receive exclusive offers and updates from Oxford Academic, Topical corticosteroids and compressive dressings, Topical corticosteroids, compressive dressings, and other, Topical corticosteroids and corticosteroid injection, Duration of thyroid disease before PTM diagnosis, Transantral orbital decompression surgery (yes, Eye surgery, excluding transantral orbital (yes.