PUVA治疗胫前粘液性水肿

Graves甲状腺毒症常并发慢性皮肤粘蛋白的浸润,特别是胫前(胫前粘液性水肿)。皮肤粘液性水肿虽可外用或病损内注射皮质类固醇治疗,但常无效。作者报告1例胫前粘液性水肿用PUVA治疗获得成功。患者女性,28岁,8个月来坐立不安、体重减轻、多汗、双眼球突出、双胫前发生粉红色坚实结节和斑块,其上毛孔口扩大。根据临床及化验检查确诊为Graves甲状腺毒症,伴发胫前粘液性水肿。因用甲状腺素和甲亢平治疗18个月无效,而行甲状腺次全切除。此后,在甲状腺素维持治疗后保持甲状腺功能正常。6个月后胫前皮损病理检查显示,真皮     

内分泌、代谢、营养障碍性皮肤病

20050976 胫前粘液性水肿1例/李杭(北京大学人民医院皮肤科),李会申,张建中//中国皮肤性病学杂志.- 2004,18(5).-295—296 20050977 胫前粘液性水肿1例/黎明(广东省皮防中心)//岭南皮肤性病科杂志.-2004,11(3).-279-280 20050978 皮肤异色病样淀粉样变病1例及家系调查/ 陈珺怡(浙江永康市中医院皮肤科),汪蓓青,陈向东// 临床皮肤科杂志.-2004,33(12).-751～752     

穴位封闭疗法治愈胫前粘液性水肿1例

穴位封闭疗法治愈胫前粘液性水肿１例桂林市中西医结合医院皮肤科邓翠荣患者女性，５７岁，因双小腿下部斑块伴破溃、流脓半年就诊。既往有甲亢病史，检查：双小腿下１／３部位皮肤呈环状肿胀，有大小不等、形状不规则之斑块，压之无凹陷，局部破溃，诊断：胫前粘液性水肿...     

胫前粘液性水肿1例

目的：报告1例胫前粘液性水肿。患者男性，23岁，双胫前水肿性结节斑块1年，患者3年前患有突眼性甲状腺肿病，于半年前作了甲状腺次全切除术，术后皮疹渐渐扩大，边界清楚，结节和非凹陷性水肿斑块更明显，无明显痛痒。现总T3、总T4正常，组织病理检查显示胫前粘液性水肿。     

突眼性甲状腺肿的少见部位的局限性粘液性水肿

本文报告了3例突眼性甲状腺肿患者,在极少见部位发生了局限性粘液性水肿。例1因突眼性甲状腺肿接受10mCi碘化钠I~(131)治疗后3个月,除在胫前外于两侧肩部出现了局限性粘液性水肿10×12     

左小腿浅表型恶性纤维组织细胞瘤1例

<正>1临床资料患者,男,43岁,左侧小腿屈侧结节1年。1年前,患者左侧小腿屈侧中下2/3处出现一个蚕豆大小的皮下结节,质中,活动度差,无明显不适,缓慢长大至小核桃大小,表面暗红,在外院诊断为"胫前粘液性水肿",皮下注射"曲安奈德"后结节有所变软,但未消退,门诊以"1、脂肪瘤?2、皮肤纤维瘤?"收入住院。既往史:4年前患"甲亢",行"碘131"治疗。     

胫前黏液性水肿14例临床病理分析

目的:分析研究胫前黏液性水肿的临床和组织病理学特点.方法:对14例胫前黏液性水肿患者的临床表现进行回顾性分析,采用苏木精-伊红染色、阿新蓝染色进行组织病理学检查.结果:14例胫前黏液性水肿患者多表现为胫前肤色、淡红色或褐黄色坚实水肿性斑块或结节.真皮中下部可见大量淡蓝色的线状或颗粒状粘蛋白沉积,胶原纤维分离,部分成纤维细胞数目增多,阿新蓝染色阳性.治疗局部采用皮质类固醇激素皮损内注射疗效显著.结论:胫前黏液性水肿的临床及组织病理具特征性,手术所见亦有助于本病的诊断与鉴别诊断.     

以色素沉着症为首发的POEMS综合征1例

1临床资料患者男,54岁。四肢色素沉着3年,四肢远端疼痛、麻木3个月。3年前患者出现四肢色素沉着,皮损组织病理示色素性紫癜性皮炎样改变,以毛细血管扩张性紫癜予以治疗(用药不详)无效。3个月前四肢远端疼痛、麻木。体检:肝肋缘下3.0 cm,质中等,脾区有叩击痛,移动性浊音(±),双下肢轻度凹陷性水肿,四肢痛觉无明显障碍,肌力正常。皮肤科情况:面颈、胸腹及四肢皮肤可见色素沉着,呈暗褐色,对称分布,不高起皮肤表面,压之不退色;眼睑、背部、腋下、肘部、腹股沟、膝部、腘窝部皮肤色素加深,可见红斑,呈向心性发展,仅上腹及胸部可见一30 cm×20 cm…     

荨麻疹伴发甲状腺机能亢进

甲状腺机能亢进(甲亢)最常见的皮肤伴发体征是胫前粘液性水肿与白癜风,较少见的是血小板减少性紫癜与黑皮病,作者报告了3例荨麻疹伴发甲亢则更为罕见。例1,女性,25岁。慢性荨麻疹,原因不明,对症治疗效果欠佳。3年后确诊有甲亢。用甲亢平(néomercazole)治疗2月后甲状腺机能恢复正常,荨麻疹亦随之消失。例2,女性。因患荨麻疹作病     

胫前黏液性水肿一例

<正>临床资料患者,男,36岁。主因双下肢散在肿物1年余、加重半年,于2010年12月3日就诊。1年前患者双胫前出现散在黄豆大小斑丘疹,无自觉症状,未予特殊处理,近半年来皮损逐渐增大,数目增多,无疼痛、瘙痒。患者既往有甲亢病史3年,于当地治疗,现血清T3、T4水平均正常。体格检查:双侧凸眼征(+),甲状腺未触及,心、肺检查未见明显异常。皮肤科检查:双胫前散在边界清楚的圆形或卵圆形坚实红色结节或斑块,其中右胫前两处斑块较大,近端斑块约5cm×6 cm、远端约10 cm×8 cm,隆起、凹凸不平,表面有蜡样光泽,界限清楚,质硬,无压痛,皮肤张     

姐妹同患硬斑病合并桥本甲状腺炎二例

报告姐妹俩同患硬斑病合并桥本甲状腺炎。例1 女,64岁,颈前、躯干和双胫前皮疹5年,会阴部皮疹伴瘙痒4年,既往桥本甲状腺炎病史9年。体检：甲状腺Ⅰ度肿大,质韧,无突眼、胫前黏液水肿等表现。颈部、前胸淡红色斑片,后背部硬化萎缩,会阴部瓷白色斑块。皮损组织病理提示：（前胸）硬斑病,（外阴）硬化萎缩性苔藓。例2 女,例1的妹妹,55岁,左乳下及腹部皮肤逐渐硬化萎缩4年,既往桥本甲状腺炎病史3年。体检：甲状腺Ⅰ度肿大,质韧,无突眼、胫前黏液水肿等表现。左乳下、腹部和后背中央皮肤色素减退,硬化萎缩。皮损组织病理提示：硬斑病。根据临床特点、组织病理、过碘酸-雪夫染色和甲状腺功能检查,2例均诊断为硬斑病合并桥本甲状腺炎。     

Pretibial Myxedema Presenting as Severe Elephantiasis

Elephantiasis is a symptom characterized by the thickening of the skin and underlying tissues in the legs. Pretibial myxedema (PTM) is a non-frequent manifestation of autoimmune thyroiditis, particularly Graves'' disease. Lesions of myxedema occur most commonly on the pretibial surfaces, also develop at sites of previous injury or scars and other areas. A 49-year-old male presented with severe elephantiasis on the both pretibial areas, dorsum of the feet, ankles and toes. Twenty years previously, he had received radioactive iodine treatment for thyrotoxicosis. Laboratory tests showed that the patient''s thyroid function was normal, but the level of thyroid stimulating hormone (TSH) receptor antibodies was very high (>40 IU/L). The biopsy confirmed PTM. Interestingly, the connective tissue was stained with the TSH receptor antibodies in the deep dermis. Elephantiasic PTM is a severe form of the myxedema and there is few reported case. We report a rare case of PTM with appearance of severe elephantiasis.     

Pretibial myxedema as the initial manifestation of Graves'' disease

Pretibial myxedema (PM) is a localized thickening of the pretibial skin due to accumulation of acid mucopolysacharides (glycosaminoglycans). Its pathogenesis is still under investigation. Pretibial myxedema, exophthalmus and thyroid acropachy are the dassic extrathyroidal manifestations of Graves' disease. Almost invariably, PM follows the onset of ophthalmopathy, developing after the diagnosis and treatment of hyperthyroidism. Pretibial myxedema preceding Graves' ophthalmopathy is rare. We report the case of a 28-year-old Greek woman, who presented with multiple, asymptomatic nodules and plaques of the lower legs in the absence of other physical findings. Histopathologic examination revealed deposition of mucopolysacharides in the lower dermis. Laboratory investigation showed elevated serum T3 and T4 and depressed TSH levels. In our patient, pretibial myxedema was the earliest manifestation, leading to the diagnosis of Graves' disease.     

A case report of EMO syndrome showing localized hyperhidrosis in pretibial myxedema.

We describe here a case of EMO syndrome, which is defined as a combination of exophthalmos, pretibial or localized myxedema, and hypertrophic osteoarthropathy. A 34-year-old Japanese man with Graves' disease developed the characteristic eye changes. He showed 22 mm protrusion of both eyes and hypertrophy of the right lateral rectus muscle as well as both superior rectus muscles by computerized tomography. He subsequently developed lightly erythematous, indurated, nonpitting, peau d'orange plaques and nodules on his lower legs. Finally, he developed Graves' acropathy with hypertrophic osteoarthropathy in the metacarpal bones. Histological examination of myxedematous skin showed typical deposition of mucin accompanied by changes in the amount and distribution of elastic fibers. In addition, the lesional skin showed localized hyperhidrosis, a rarely reported complication of pretibial myxedema. We speculate that this hyperhidrosis of the lesional skin was brought about by stimulation of peripheral sympathetic nerves by surrounding mucin deposition, in the setting of poorly controlled hyperthyroidism.     

Pretibial mucinosis in a patient without Graves disease

Although an uncommon location, cutaneous mucinoses may present in the pretibial area in distinct clinical circumstances. The terms pretibial myxedema and pretibial mucinosis often are used interchangeably, but pretibial myxedema should be regarded as a type of pretibial mucinosis. We present a case of cutaneous mucinosis localized to the pretibial area of a patient without Graves disease.     

Preradial myxedema in thyroid disease

Patients with Graves' disease were noted to have thickening of the skin on the extensor surfaces of their forearms. Skin biopsy specimens were obtained from nine consecutive patients with Graves' disease treated with sodium iodide I 131, from three patients with other thyroid disorders, and from one patient with acromegaly. Skin specimens from one patient with scleredema and one patient with scleromyxedema were used as controls for the histologic stains. Hematoxylin-eosin-stained sections of forearm skin from eight of nine patients with Graves' disease showed prominent round-cell (probably lymphocytic) infiltration around dermal capillaries and distortion of collagen fibers. In five of the patients with Graves' disease, staining with Mowry's colloidal iron disclosed dense deposits of mucin in the papillary dermis, with a distribution similar to that reported for pretibial myxedema. Mucopolysaccharide deposition in the skin on the extensor surface of the forearms may be the clinical counterpart of pretibial myxedema.     

Acral Ichthyosiform Mucinosis in Association with Sjögren's Syndrome: A Peculiar Form of Pretibial Myxedema?

Two Japanese women developed well-dermarcated ichthyosiform plaques on the lateral aspect of their lower legs. Deposition of mucin was demonstrated throughout the papillary dermis, unlike the site of mucin deposition seen in pretibial myxedema. Their thyroid function was normal. The condition of both women was complicated by Sjögren's syndrome. One of them who presented with positive anti-microsomal and anti-thyroglobulin antibodies had goiter, suggesting that her malady was also complicated by Hashimoto's thyroiditis. Their skin manifestations differed from those described in cutaneous mucinosis including pretibial myxedema, specifically with regard to the well-demarcated ichthyosiform appearance, the mucin deposition in the papillary dermis, and the association with Sjögren's syndrome. To the best of our knowledge, our cases may thus be considered to be a previously undescribed form of cutaneous mucinosis associated with Sjögren's syndrome.     

UVA1治疗皮肤病的现状

在过去的30年中,UVA1因能进入皮肤深层诱导T细胞凋亡,下调多种细胞因子,激活内皮细胞并促进血管新生,逐渐被用于治疗各种皮肤疾病.目前有随机对照队列研究证据的疾病包括特应性皮炎、局限性硬皮病、系统性红斑狼疮,其他的适应证还有皮肤T细胞淋巴瘤、系统性硬皮病、胫前黏液性水肿、结节性痒疹等.相比其他光疗法,UVA1的近期不良反应相对较少,远期副作用目前尚无报道,仍需跟踪随访.     

Successful therapeutic approach in a patient with elephantiasic pretibial myxedema

Localized pretibial myxedema is a dermopathy whose treatment is a challenge in dermatology, occurring in 0.5–4% of patients with Graves’ disease. This autoimmune thyroid condition stimulates the production of hyaluronic acid and glycosaminoglycans that are deposited particularly in the pretibial region. Clinically, it presents as a localized, circumscribed, and non-depressible infiltrate in plaques. Several treatment modalities have been proposed, and their results vary, with worse response observed in severe cases. This report presents the case of a patient with elephantiasic pretibial myxedema who was subjected to intralesional corticosteroid applications, resulting in an excellent and encouraging therapeutic response that was maintained.