Pretibial Myxedema - Pictures, Treatment, Symptoms, Causes
What is Pretibial Myxedema?
This is not only a medical condition but is also a rare complication of Grave’s Disease, which is an autoimmune disease that affects your thyroid gland and frequently causes it to become two or more times its regular size and become overactive. In patients who have severe Grave’s ophthalmopathy, which is a thyroid eye disease, approximately four percent have pretibial myxedema. Of the patients that develop pretibial myxedema, approximately twenty-five percent of them develop the extreme form of this medical condition. Women who have Grave’s disease are three and half times more likely to develop the severe form than men. This medical condition usually happens to older people with the peak incidences happening in their fifties and sixties.
It is also referred to as thyroid dermopathy, Myxoedema tuberosum, Jadassohn-Dosseker disease, or localized myxedema. Pretibial myxedema is used to describe lesions of your skin that are localized. When they are referring to the pretibial area of your body the physician is talking about your shin and the front part of your lower legs.
When a person has pretibial myxedema it is characterized by:
- A localized thickening of the skin primary on the lower legs and shins. It can affect your shoulders, upper legs, back, arms, neck, face, torso, and ears.
- With the skin thickening it can be accompanied by dryness, edema that is non-pitting which means when you put pressure on the area of edema the indentation that you made does not remain, itching, and waxy lesions
- Swollen or lumpy appearance on your shins or feet
- Your skin may turn purplish or pinkish in color.
- Your skin may hand an orange peel appearance.
- The hair follicles can become highly visible and prominent.
- In some cases your skin changes may have lesions that look like warts
If the lesions are compressing blood vessels or nerves there can be impaired blood circulation and pain. In severe cases of pretibial myxedema your skin can resemble the skin of an elephant. When you have these lesions they will heal up slowly.
It is not well known just exactly what the underlying disease process is with this medical condition. It is also thought that when you have treatment for Grave’s hyperthyroidism using radioactive iodine this could trigger pretibial myxedema. There are other triggers, or causes, that include:
- Thyroid hormone imbalance which can be too high or too low and causes the thickening of your skin.
- Smoking tobacco
The physician may feel that you have pretibial myxedema by just looking at the characteristic changes in your skin that are characteristic with either Graves’ ophthalmopathy or Graves’ disease. To confirm it you will need to have a skin biopsy.
In most patients with pretibial myxedema they do not require treatment as the lesions are usually mild. In half of the patients that have a mild case of pretibial myxedema within three to five years the symptoms will spontaneously resolve on their own. If you have itchiness or a burning sensation you can apply petroleum jelly to the area. You can also use an over-the-counter or see your physician for a prescription for topical corticosteroids. When you apply them to the affect area you need to cover them with occlusive dressing or cellophane. If there are other areas of your body that are affected by pretibial myxedema you should see your physician because you may have systemic involvement. If so you may need to have oral corticosteroids. For severe cases you may have to be treated with "intravenous immunoglobulin".