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Pretibial myxedema - Skin
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Pretibial myxedema - Skin

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Contributors: Belinda Tan MD, PhD, Noah Craft MD, PhD, Lindy P. Fox MD, Lowell A. Goldsmith MD, MPH, Michael D. Tharp MD
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Synopsis

Pretibial myxedema is an uncommon dermopathy associated with Graves disease. It is present in fewer than 5% of patients, yet it is the second most common extrathyroidal manifestation of Graves disease. Rare cases have occurred with Hashimoto thyroiditis and in euthyroid patients. The precise pathogenesis is unknown. There is localized dermal accumulation of mucopolysaccharides (hyaluronic acid), presenting clinically as diffuse nonpitting lesions or sharply circumscribed lesion(s) of the anterior lower leg. It may be more appropriately called thyroid dermopathy as it can arise anywhere including the hands, arms, shoulders, ankles, ears, face, and in skin grafts, surgical scars, sport injuries, and animal bites.

Pretibial myxedema may exist in various clinical forms. The nonpitting type is most common, followed by nodular and plaquelike forms. Polypoid and elephantiasic types are rare, presenting in less than 1% of cases. Patients may demonstrate coexistence of more than one type. The lesions are usually asymptomatic. Rarely, they may cause pain or ulcerate. Pretibial myxedema may occur in any age group or either sex but is more common in older adults and women.

In contrast to cellulitis, pretibial myxedema is often bilateral and evolves slowly. It may be more violaceous and have a "waxy" appearance. Look for other manifestations of thyroid disease.

Codes

ICD10CM:
E05.80 – Other thyrotoxicosis without thyrotoxic crisis or storm

SNOMEDCT:
78146007 – Pretibial myxedema

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Last Updated: 10/12/2016
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Pretibial myxedema - Skin
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Pretibial myxedema : Erythema, Lower extremity edema, Anterior lower leg, Smooth plaques
Clinical image of Pretibial myxedema
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