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

作　　者：Fan Zhang Xin-Yue Lin Jian Chen Shi-Qiao Peng Zhong-Yan Shan Wei-Ping Teng Xiao-Hui Yu Fan Zhang;Xin-Yue Lin;Jian Chen;Shi-Qiao Peng;Zhong-Yan Shan;Wei-Ping Teng;Xiao-Hui Yu(Department of Endocrinology and Metabolism,Institute of Endocrinology,Liaoning Provincial Key Laboratory of Endocrine Diseases,The First Affiliated Hospital of China Medical University)

机构地区：[1]Department of Endocrinology and Metabolism,Institute of Endocrinology,Liaoning Provincial Key Laboratory of Endocrine Diseases,The First Affiliated Hospital of China Medical University

出　　处：《World Journal of Clinical Cases》2018年第14期854-861,共8页世界临床病例杂志

摘　　要：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 afteran 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 for8 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.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 wasused 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 afteran 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 appli-cation of a glucocorticoid ointment is a more convenient treatment for patients with PTM.

关 键 词：Intralesional injection Pretibial myxedema GLUCOCORTICOID HALOMETASONE Triamcinolone acetonide Case report 

分 类 号：R581.2[医药卫生—内分泌]