Insidious-Onset Indurated Plaques on the Shins

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.

Pentoxifylline in dermatology

“…Pentoxifylline has been used with success in case reports of dermatologic diseases including post‐erysipelas panniculitis ossificans, pretibial myxedema of graves' disease, subcorneal pustular dermatosis, Kasabach–Merritt syndrome, calciphylaxis ulcers, sickle cell leg ulcers, toxic epidermal necrolysis and febrile ulceronecrotic Mucha–Habermann disease 68–77 …”