Pretibial myxedema as part of a combined pathology

Background. One of the topical issues in medicine is the interrelation between skin pathology and endocrine-metabolic disorders, which, in addition to damage to internal target organs, can lead to morphofunctional changes in skin. Pretibial myxedema (PTM) is most often observed in patients with Graves disease and is a pathology accompanied by mucinous changes in skin, mainly in the area of the anterior surface of shins.

Results. We present our own clinical observation of a case of development of pretibial myxedema of the lower extremities in a man in combination with eczema and onychodystrophy associated with prior thyroidectomy. Among the features of the combined pathology, it is necessary to note: appearance of rashes after thyroidectomy due to thyrotoxicosis and subsequent irregular intake of replacement therapy by the patient; unilateral appearance of mucinous plaques on the anterior surface of the shin in the beginning; overlay of symptoms of eczema on the posteromedial surface of the other shin; signs of onychodystrophy of non-mycotic genesis and edema of the toes; resistance of the eczematous process to the treatment provided. For differential diagnostics, a skin biopsy was performed, which showed the presence of histological signs of mucinosis and an eczematous process, which constitute the spectrum of comorbidity the patient has. Taking into account the important role of the hormonal state in development of these diseases, it shall be assumed that there are similar pathogenetic mechanisms of development of these dermatoses in the patient. Furthermore, local vascular changes and occurrence of lymphostasis in the lower extremities in case of pretibial myxedema could apparently also lead to development of an eczematous process similar to varicose eczema, which was also an important factor contributing to the development of combined dermatoses.

Conclusion. Understanding causes and common factors of formation of multimorbid skin diseases with endocrine pathology is critically important for a dermatologist, because it makes it possible to timely diagnose and prevent the development of permanent skin pathology leading to decrease in the quality of life.

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