Pretibial myxedema (PM) is a rare extrathyroidal manifestation of Graves disease for which there is no specific treatment. When the clinical picture is markedly evident, topical treatment with steroid ointments is practised. There has been previous experience of subcutaneous injections with steroids by using standard needles, but this procedure caused nodular degeneration of the skin. Aim of the present study was to experiment a novel modality of treatment with the injection of a solution of dexametasone (DXM) in the subcutaneous area by needles used for mesotherapy. These needles are no more than 2 mm long and allow injection of the drug within the dermis or the first layer of the subcutaneous fat. We have treated 5 patients, 4 with the diffuse and one with the elephanthiasic form. We have carried out multiple injections of a solution of DXM, lidocaine and saline in the pretibial area either on the PM plaque or in the area surrounding the lesions, once a week for 3 consecutive weeks. Two patients, with the more severe forms, were submitted to another 2 cycles 4-6 weeks after the initial treatment. Patients were evaluated before and after treatment by clinical assessment and ultrasound scan of the pretibial skin, as previously reported. The treatment was well tolerated with only moderate pain upon injection of the solution. One month after treatment all patients showed improvement of PM at clinical assessment and reduction of the thickness of the pretibial lesions by ultrasound of about 15%, for both the dermis and the subcutaneous fat. Moreover, all patients reported amelioration of the leg appearance and were satisfied with the therapy. In one patient, subjected to 2 cycles of treatment, we could show a further reduction of the PM skin thickness. The present study, although preliminary, shows that intralesional steroid injection with mesotherapy needles in PM is effective and well tolerated, without producing undesidered modification of the skin. Whether this treatment is able to modify the natural history of PM is still to be ascertained. Furthermore, more studies are warranted to determine the optimal dosage of the steroid to be administered and the number of therapy cycles.
01 - 05 Apr 2006
European Society of Endocrinology