Intralesional and topical glucocorticoids for pretibial myxedema: A case report and review of literature

Abstract

Pretibial myxedema (PTM), an uncommon manifestation of Graves’ disease (GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with PTM who achieved complete remission by multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application for a self-controlled study. A 53-year-old male presented with a history of GD for 3.5 years and a history of PTM for 1.5 years. Physical examination revealed slight exophthalmos, a diffusely enlarged thyroid gland, and PTM of both lower extremities. One milliliter of triamcinolone acetonide (40 mg) was mixed well with 9 mL of 2% lidocaine in a 10 mL syringe. Multipoint intralesional injections into the skin lesions of the right lower extremity were conducted with 0.5 mL of the premixed solution. A halometasone ointment was used once daily for PTM of the left lower extremity until the PTM had remitted completely. The patient’s PTM achieved complete remission in both legs after an approximately 5-mo period of therpy that included triamcinolone injections once a week for 8 wk and then once a month for 2 mo for the right lower extremity and halometasone ointment application once daily for 8 wk and then once 3-5 d for 2 mo for the left lower extremity. The total dosage of triamcinolone acetonide for the right leg was 200 mg. Our experience with this patient suggests that multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application are safe, effective, and convenient treatments. However, the topical application of a glucocorticoid ointment is a more convenient treatment for patients with PTM.

An atypical presentation of pretibial myxedema in a euthyroid patient with absent antithyroid autoantibodies

“…Intralesional and topical corticosteroids are considered first-line therapy for PTM, although topical application appears to be significantly less effective. 1 , 8 , 9 Zhang et al 8 reported nearly 100% complete response rates to weekly injections of intralesional triamcinolone 10 mg/mL for all variants with the exception of elephantiasis, which had a partial response in 73% of patients. In a case series of 178 patients with PTM, only 20.8% of the 96 patients treated with topical corticosteroids achieved complete remission over an average of 8.8 years.…”