Localized myxedema involving the upper extremities

Thyroid hormone and wound healing

Although thyroid hormone is one of the most potent stimulators of growth and metabolic rate, the potential to use thyroid hormone to treat cutaneous pathology has never been subject to rigorous investigation. A number of investigators have demonstrated intriguing therapeutic potential for topical thyroid hormone. Topical T3 has accelerated wound healing and hair growth in rodents. Topical T4 has been used to treat xerosis in humans. It is clear that the use of thyroid hormone to treat cutaneous pathology may be of large consequence and merits further study. This is a review of the literature regarding thyroid hormone action on skin along with skin manifestations of thyroid disease. The paper is intended to provide a context for recent findings of direct thyroid hormone action on cutaneous cells in vitro and in vivo which may portend the use of thyroid hormone to promote wound healing.

Thyroid hormone action on skin

PURPOSE OF REVIEW

To review the current understanding regarding thyroid hormone action on skin. To provide a historical context for the recent findings.

RECENT FINDINGS

Although direct thyroid hormone actions have been demonstrated on multiple aspects of cutaneous biology, rigorous study remains scant. Still, there is a slowly evolving literature supporting the concept that thyroid hormone can directly stimulate epidermis, dermis, and hair. That action may be accessed to treat cutaneous disease.

SUMMARY

Here, we review the literature regarding thyroid hormone action on skin along with skin manifestations of thyroid disease. We provide context for more recent findings of direct thyroid hormone stimulation of cutaneous cell proliferation in vitro and in vivo which may portend the use of thyroid hormone to treat cutaneous pathologies.

Pretibial myxoedema presenting as a scar infiltrate

A 41-year-old man developed pretibial myxoedema localized to scars following treatment for hyperthyroidism. Pre-existing scars on both lower legs, present for more than 20 years, were infiltrated with firm and nonpitting nodules and plaques over his shins. The clinical presentation of this patient highlights pretibial myxoedema as a cause of scar infiltration. The pathogenesis of pretibial myxoedema is reviewed.

Myxoedematous infiltrate of the forehead in treated hypothyroidism

A 42-year-old man presented with a 3 month history of erythema and thickening of the forehead skin. He had been diagnosed as hypothyroid 10 years previously and treated with thyroxine at adequate dosage, according to thyroid function tests. Histology confirmed a myxoedematous infiltrate. The forehead is an unusual site for deposition of mucin and the late appearance, 10 years after treatment, is also uncharacteristic. Myxoedema in the usual pretibial site is a feature of Graves' disease. This man, however, had been hypothyroid with no features of Graves' disease suggesting that there are additional factors other than thyroid status and thyroid autoimmune disease which may be important in the development of myxoedematous infiltrates.

Orbital decompression in Graves' ophthalmopathy associated with pretibial myxedema

Pretibial myxedema (thyroid dermopathy), an uncommon autoimmune manifestation of Graves' disease, is almost always associated with significant ophthalmopathy and may be a marker for an unusually prolonged or different course for the ophthalmopathy. However, it is not known if the response to therapy for eye disease is different in patients with pretibial myxedema. We compared the results of orbital decompression in 385 patients without and 52 patients with pretibial myxedema operated on between 1969 and 1989. Preoperative and postoperative characteristics of severe Graves' ophthalmopathy did not differ in patients with or without pretibial myxedema except for slightly, but not significantly, more proptosis and diplopia in the pretibial myxedema group. In response to a 1989-1990 questionnaire (83% response rate, n = 364), 89.1% without (n = 319) and 88.9% with (n = 45) pretibial myxedema reported satisfactory or acceptable appearance of the eyes. Self-assessment of visual acuity, eye comfort, diplopia, and overall rate of satisfaction with the status of the eyes did not differ between the groups. The presence of pretibial myxedema does not herald an unsatisfactory response to transantral orbital decompression.

Localized myxedema on the nasal dorsum in a patient with Graves' disease: report of a case

We report the case of a 56-year-old Japanese female with Graves' disease associated with localized myxedema on the nasal dorsum. The patient developed localized myxedema concomitantly with hyperthyroidism before antithyroid therapy was given. The lesion was totally removed surgically, as it was small and well circumscribed. Although unusual locations of localized myxedema have been reported elsewhere, there is to date no case of localized myxedema on the nasal dorsum without involvement of the pretibial area reported in the literature. We discuss this unique feature of our patient.

Endocrine-skin interactions. Cutaneous manifestations of pituitary disease, thyroid disease, calcium disorders, and diabetes

Endocrinologic disorders occasionally manifest themselves by their associated or induced cutaneous abnormalities. In some instances the initial and most prominent complaints of the patient are related to alterations in the skin, and thus the dermatologist will at times be the first physician consulted. In this article we describe the cutaneous lesions that occur in patients with acromegaly, hypopituitarism, hypothyroidism, hyperthyroidism, diabetes mellitus, glucagonomas, hypercalcemia, hypoparathyroidism, and fibrous dysplasia. In addition, we also discuss the role of the skin in vitamin D metabolism. Whenever possible and where known, we have attempted to point out the pathophysiologic mechanisms that account for the cutaneous changes.

The cutaneous mucinoses

The cutaneous mucinoses are a group of connective tissue disorders characterized by the deposition of mucin, either focally or diffusely, in the interstices of the dermis. The diseases may be a primary (metabolic) or secondary (catabolic) process. Systemic abnormalities are seen with most of these disorders. This review discusses the primary mucinoses in which the predominant dermal mucin is hyaluronic acid. Current therapy and proposed mechanisms for the mucinoses are considered.