The pigmented purpuric dermatoses (PPDs) are a group of benign, chronic diseases. The variants described to date represent different clinical presentations of the same entity, all having similar histopathologic characteristics. We provide an overview of the most common PPDs and describe their clinical, dermatopathologic, and epiluminescence features. PPDs are both rare and benign, and this, together with an as yet poor understanding of the pathogenic mechanisms involved, means that no standardized treatments exist. We review the treatments described to date. However, because most of the descriptions are based on isolated cases or small series, there is insufficient evidence to support the use of any of these treatments as first-line therapy.
A previous report showed a 10% complete remission rate after an average follow-up of 3.5 years in 150 patients with pretibial myxedema. 2 According to another study of long-term outcome of pretibial myxedema in 178 patients with pretibial myxedema, a 50% complete remission rate was achieved after 17 years in patients who had gone untreated for cutaneous lesions. 3 In contrast, our patient developed a marked deterioration over a period of 14 years. Mild cases may show spontaneous regression, while severe cases such as elephantiasic pretibial myxedema are refractory to therapies. Fibroblast stimulation is suggested to play an important role in the increased production of glycosaminoglycan in myxedema; however, the differences between progressive and smoldering types are unknown. A recent report suggested a possible novel treatment with complete decongestive physiotherapy for elephantiasic enlargement of the lower legs. 4 Because our patient had stopped visiting the hospital, untreated thyroid disease, diabetes, hyperlipidemia, hypertension, and abnormality in echocardiogram were newly discovered when she revisited us after the interval. Due to the metabolic syndrome, surgical treatment for her nodular and elephantiasic myxedema of the lower legs could not be performed. In conclusion, even though the symptoms were mild at the initial presentation, long-term follow-up of pretibial myxedema is necessary to confirm the disease progression.
Presentamos el caso de un varón de 66 años, fumador de 102 paquetes/año y hábito de consumo enólico, que acudió a consulta por presentar unas tumoraciones subcutáneas asintomáticas de un año de evolución en las plantas de los pies. A la exploración física se apreciaban nódulos firmes adheridos a planos profundos (fig. 1A y B).Se realizó una ecografía de ambas plantas de los pies con un transductor lineal de alta frecuencia (7,(5)(6)(7)(8)(9)(10)(11)(12)(13). En el eje largo identificaron lesiones hipoecoicas e isoecoicas de morfología fusiforme, perfiles nodulares y bordes regulares, con refuerzo acústico posterior y sin registro Doppler color.
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