Thyroid Research Thyroid Research Archive Graves' Disease

Limited benefit of topical glucocorticoid therapy in localized dermopathy of Graves' disease

(July 2002)

The background of the study. Localized dermopathy (pretibial myxedema) is a rare manifestation of Graves' disease, and little is known about its natural history and the effects of treatment.

How the study was done. The study subjects were 178 patients given a diagnosis of localized dermopathy between 1969 and 1995. The diagnosis was based on the presence of raised, waxy, sometimes indurated, skin lesions on the lower legs (rarely on the feet or arms), varying in color from lighter to darker than the adjacent skin. Treatment varied from none to topical glucocorticoid therapy covered by an occlusive dressing, applied one to three times daily, usually for two to ten weeks; a few patients were treated with subcutaneous injections of glucocorticoids.

The records were reviewed, and in 2000 the patients were sent a questionnaire asking about any treatment for their skin after their last clinic visit and about their current status. The mean follow-up period was eight years. Outcome was categorized as complete remission (no skin lesions), moderate improvement, and minimal or no change, at the last time for which information was available.

The results of the study. There were 142 women and 36 men (mean age, 53 years); 91 percent had hyperthyroidism, 6 percent had hypothyroidism, and 3 percent had normal thyroid function. Thyroid disease preceded dermopathy in most patients, and all the patients had Graves' eye disease.

Fifty-four percent of the patients were treated with one or more courses of topical glucocorticoids, and 46 percent were not treated. Overall, 26 percent of the patients had a complete remission (mean time, nine years) of their skin disease, 24 percent had moderate improvement, and 50 percent had little or no improvement. The outcomes in the treated and untreated patients were similar, but the treated patients may have had more severe disease.

The conclusions of the study. Graves' dermopathy resolves slowly or not at all with time, and topical glucocorticoid therapy has limited benefit.

The original article. Schwartz KM, Fatourechi V, Ahmed DD, Pond GR. Dermopathy of Graves' disease (pretibial myxedema): long-term outcome. J Clin Endocrinol Metab 2002;87:438-46.