title: Long-term follow-up and epidemiological trends in patients with pretibial myxedema: an 11-year study from a tertiary care center in northern India.
abstract: BACKGROUND
  Pretibial myxedema (PTM) is a rare manifestation of Graves' disease. There is paucity of data regarding long-term follow-up and response to treatment in PTM.
  
  
  METHODS
  Retrospective study wherein 30 patients of PTM presenting during 2001-2011 attending dermatology and endocrinology outpatient departments were analyzed.
  
  
  RESULTS
  Among 30 patients with PTM, 12 were males and 18 females with a ratio of 1 : 1.5 males/females. Four morphological forms were identified: plaques (18 patients), diffuse non-pitting edema of both lower legs (five), nodules (five), and elephantiasis lesions (two). Eighty percent were diagnosed with hyperthyroidism before the development of dermopathy. Twenty-six patients presented with ophthalmopathy. Fourteen patients with plaque had an excellent response to topical clobetasol propionate ointment and attained complete resolution by 3.6 years. Out of 16 patients treated with combination therapy, which included nine treated with topical corticosteroids/intralesional triamcinolone and seven treated with oral, intralesional, and topical corticosteroids, nine attained complete resolution in the lesions by 3.4 years, and none relapsed anytime during four years of post-treatment follow-up. However, the remaining patients (elephantiasis and diffuse forms) failed to achieve complete resolution.
  
  
  CONCLUSIONS
  Plaques and nodules are common variants with a favorable clinical response to topical and intralesional corticosteroid; elephantine and diffuse forms responded poorly to therapy. Studies analyzing larger cohorts of patients with PTM and their long-term follow-up are limited, hence more such studies are required.
authors.affiliation: Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Muthu
authors.initials: M
authors.lastname: Sendhil Kumaran
authors.affiliation: Department of Endocrinology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Pinaki
authors.initials: P
authors.lastname: Dutta
authors.affiliation: Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Uma
authors.initials: U
authors.lastname: Sakia
authors.affiliation: Department of Dermatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Dogra
mesh_terms: D000279:Administration, Cutaneous; D000284:Administration, Oral; D000328:Adult; D000368:Aged; D002990:Clobetasol / Q000008:administration & dosage*; D004359:Drug Therapy, Combination; D004604:Elephantiasis / Q000188:drug therapy / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D005938:Glucocorticoids / Q000008:administration & dosage*; D049970:Graves Ophthalmopathy / Q000209:etiology / Q000601:surgery; D006801:Humans; D007194:India / Q000453:epidemiology; D015552:Injections, Intralesional; D007868:Leg Dermatoses / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009230:Myxedema / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D009824:Ointments / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage*; D014284:Triiodothyronine / Q000097:blood
chemical_list: D005938:Glucocorticoids; D009824:Ointments; D014284:Triiodothyronine; D014221:Triamcinolone; D013972:Thyrotropin; D011239:Prednisolone; D002990:Clobetasol; D013974:Thyroxine