September 2021 - Case of the Month
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 62 year-old man presented with a six-month history of progressive skin changes to his shins, which had become tender to touch. He had also noted changes to his nails. There was no other personal or family history of skin problems, and he was on no regular medications.
Examination of the shins revealed tender, symmetrical, plaques with some focal areas of oedema. The nails showed signs of acropachy, which has a similar appearance to clubbing, and there was subtle peri-orbital oedema.
What is the diagnosis?
The diagnosis is pre-tibial myxoedema (PTM)
PTM is nearly always associated with Graves disease. The onset of PTM occurs most commonly 1-2 years after the onset of Graves disease, but as with this patient it can occur before the thyrotoxicosis develops. Most patients will also develop Graves ophthalmopathy. The classic triad of Graves is PTM, Graves ophthalmopathy and thyroid acropachy.
Early lesions on the shins are bilateral, firm, non-pitting plaques. Peau d'orange like change is common.
The primary aspect of management is the thyroid disease. PTM is difficult to treat but is usually self-limiting. Potent topical steroids are sometimes used if the skin is very uncomfortable, and compression hosiery may be needed if the legs become very swollen. Approximately 25% of patients get partial remission, and upto 25% of patients achieve full remission of the PTM.
A 24-year-old woman presented with a several year history of evolving 'lumps' especially on the central chest. The lady had mild facial acne and was otherwise well.
A 52 year old man presented with a one year history of skin lesions predominantly on his hands, ears and scalp. He was also complaining of painful swollen fingers associated with morning stiffness. There was no family history of skin or joint problem...
A 72 year old man was referred with a rash, predominantly on the legs. The patient was systemically well and the lesions were only mildly symptomatic. The lesions presented as one to several at a time lasting several weeks. They had not res...
Welcome back to the new look PCDS website, and our first case. This lady was referred as a 2-week wait with a changing lesion on the right temple.
A 15 year old lady was referred for a diagnostic opinion for skin changes presenting in birth, affecting the right upper back, shoulder, antecubital fossa and dorsal wrist. The patient was asymptomatic and otherwise well.
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