DermAtlas: Online Dermatology Image Library dermatology image,myxedema, pretibial,myxedema, pretibial,myxedema, pretibial,myxedema, pretibial,myxedema, pretibial,acropachy, thyroid,myxedema, pretibial,Grave disease,myxedema, pretibial,acropachy, thyroid,myxedema, pretibial,acropachy, thyroid,myxedema, pretibial,myxedema, pretibial,acropachy, thyroid

© 2001-2010, DermAtlas	*Image Name:*	pretibial_myxedema_1_060327	*File Type:*	jpg
	*Diagnosis:*	MYXEDEMA, PRETIBIAL	*Category:*	thyroid disease associated / Metabolic disorders
	*Body Site:*	leg	*Age:*	63 years
	*Contributors:*	David Cowan Greg Hosler, MD, PhD
	*Description:*	Histologic sections of skin show a band-like area of clear matrix deposition with increased intercellular space at mid-dermal levels. The deposition is ill-defined, not forming a discrete mass. The adnexal structures are undisturbed. The overlying epidermis is slightly acanthotic.
	*Comments:*	This 63-year-old African-American woman presented to dermatology with a 1-year history of an asymptomatic nodule on her right shin. The lesion was biopsied to rule out panniculitis. Following the biopsy findings, a remote history of poorly controlled hyperthyroidism was ascertained. This histology is classic for pretibial myxedema. The etiology is unclear, but it is often seen in patients with hyperthyroidism. The pathogenesis is thought to relate to circulating fibroblastic stimulating factors, causing production of mucinous matrix.
	*Related Images:*	All related Images pretibial_myxedema_3_060327 pretibial_myxedema_2_060327

© 2001-2010, DermAtlas	*Image Name:*	pretibial_myxedema_2_060327	*File Type:*	jpg
	*Diagnosis:*	MYXEDEMA, PRETIBIAL	*Category:*	thyroid disease associated / Metabolic disorders
	*Body Site:*	leg	*Age:*	63 years
	*Contributors:*	David Cowan Greg Hosler, MD, PhD
	*Description:*	An alcian blue stain confirms the presence of mucin.
	*Comments:*	This 63-year-old African-American woman presented to dermatology with a 1-year history of an asymptomatic nodule on her right shin. The lesion was biopsied to rule out panniculitis. Following the biopsy findings, a remote history of poorly controlled hyperthyroidism was ascertained. This histology is classic for pretibial myxedema. The etiology is unclear, but it is often seen in patients with hyperthyroidism. The pathogenesis is thought to relate to circulating fibroblastic stimulating factors, causing production of mucinous matrix.
	*Related Images:*	All related Images pretibial_myxedema_3_060327 pretibial_myxedema_1_060327

© 2001-2010, DermAtlas	*Image Name:*	pretibial_myxedema_3_060327	*File Type:*	jpg
	*Diagnosis:*	MYXEDEMA, PRETIBIAL	*Category:*	thyroid disease associated / Metabolic disorders
	*Body Site:*	leg	*Age:*	63 years
	*Contributors:*	David Cowan Greg Hosler, MD, PhD
	*Description:*	At higher power of the same lesion, spindled-to-stellate fibroblasts float within this myxoid stroma. Cytologic atypia is not noted.
	*Comments:*	This 63-year-old African-American woman presented to dermatology with a 1-year history of an asymptomatic nodule on her right shin. The lesion was biopsied to rule out panniculitis. Following the biopsy findings, a remote history of poorly controlled hyperthyroidism was ascertained. This histology is classic for pretibial myxedema. The etiology is unclear, but it is often seen in patients with hyperthyroidism. The pathogenesis is thought to relate to circulating fibroblastic stimulating factors, causing production of mucinous matrix.
	*Related Images:*	All related Images pretibial_myxedema_2_060327 pretibial_myxedema_1_060327

© 2001-2010, DermAtlas	*Image Name:*	pretibial_myxedema_2_060306	*File Type:*	jpg
	*Diagnosis:*	MYXEDEMA, PRETIBIAL	*Category:*	thyroid disease associated / Metabolic disorders
	*Body Site:*	thigh	*Age:*	51 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	An alcian blue stain confirms the mucinous nature of the deposition within the superficial reticular dermis.
	*Comments:*	This 51-year-old has a long history of hyperthyroidism and fairly recently developed ill-defined plaques on the extensor surfaces of her lower extremities. The biopsy was submitted to rule out panniculitis. This is a classic case of pretibial myxedema. Patients often have a history of hyperthyroidism, although the skin manifestations may not correlate with the level of hyperthyroidism. The etiology is uncertain, but fibroblastic stimulators/growth factors have been implicated. The histology shows copious amounts of mucin within the interstitium, sometimes in the deep dermis and other times in the superficial reticular dermis, as in this case. Mucin stains confirm the diagnosis.
	*Related Images:*	pretibial_myxedema_1_060306

© 2001-2010, DermAtlas	*Image Name:*	pretibial_myxedema_1_060306	*File Type:*	jpg
	*Diagnosis:*	MYXEDEMA, PRETIBIAL	*Category:*	thyroid disease associated / Metabolic disorders
	*Body Site:*	thigh	*Age:*	51 years
	*Contributor:*	Greg Hosler, MD, PhD
	*Description:*	Histologic sections of skin show epidermal papillomatosis and acanthosis with a band-like deposition within the superficial reticular dermis. The extracellular space is expanded, splaying collagen fibers and leaving only a sparse cellular network of spindled-to-stellate cells. The matrix deposits around vascular and adnexal structures, without distortion.
	*Comments:*	This 51-year-old has a long history of hyperthyroidism and fairly recently developed ill-defined plaques on the extensor surfaces of her lower extremities. The biopsy was submitted to rule out panniculitis. This is a classic case of pretibial myxedema. Patients often have a history of hyperthyroidism, although the skin manifestations may not correlate with the level of hyperthyroidism. The etiology is uncertain, but fibroblastic stimulators/growth factors have been implicated. The histology shows copious amounts of mucin within the interstitium, sometimes in the deep dermis and other times in the superficial reticular dermis, as in this case. Mucin stains confirm the diagnosis.
	*Related Images:*	pretibial_myxedema_2_060306

© 2001-2010, DermAtlas	*Image Name:*	Grave_1_030306	*File Type:*	jpg
	*Diagnosis:*	ACROPACHY, THYROID / MYXEDEMA, PRETIBIAL / GRAVE DISEASE	*Category:*	cutaneous sign of systemic disease / Metabolic disorders / thyroid disease associated
	*Body Site:*	hand	*Age:*	67 years
	*Contributor:*	Rebecca Kazin, MD
	*Description:*	acropachy with soft tissue swelling of digits, joint enlargement, and clubbing of fingers
	*Comments:*	This 67-year-old man had a history of hypothyroidism for which he received L-thyroxine. Two years later he was diagnosed with ophthalmopathy from Grave disease. He was treated with propylthiouracil and prednisone. He subsequently developed pretibial myxedema and acropachy.
	*Related Images:*	Grave_2_030306

© 2001-2010, DermAtlas	*Image Name:*	myxedema_6_030205	*File Type:*	jpg
	*Diagnosis:*	MYXEDEMA, PRETIBIAL / ACROPACHY, THYROID	*Category:*	cutaneous sign of systemic disease / Metabolic disorders / lumps & bumps (plaques, nodules, tumors)
	*Body Site:*	hand	*Age:*	52 years
	*Contributor:*	Michael Viglione, MD
	*Description:*	The deep reticular dermis contains mild perivascular lymphocytic infiltrate. Many of the deep dermal collagen fibers are separated from one another. Alcian blue demonstrates increased interstitial mucin within the deep dermis.
	*Comments:*	These histologic features are typical of pretibial myxedema.

© 2001-2010, DermAtlas	*Image Name:*	myxedema_5_030205	*File Type:*	jpg
	*Diagnosis:*	MYXEDEMA, PRETIBIAL / ACROPACHY, THYROID / GRAVE DISEASE	*Category:*	lumps & bumps (plaques, nodules, tumors) / Metabolic disorders / cutaneous sign of systemic disease / hyperpigmentation
	*Body Site:*	hand / finger	*Age:*	52 years
	*Contributor:*	Bernard Cohen, MD
	*Description:*	dramatic thichening and hyperpigmentation with deep ridges
	*Comments:*	This 52-year-old woman with a 5 year history of goiter and Grave disease developed progressive nontender thickening with exuberant folding of the skin on the shins and tops of the feet. She also had nontender subcutaneous nodules on her upper legs, hands, and arms, diffuse thickening of the soft tissue of the hands and fingers and thickening of the soft tissue of the orbits with bilateral proptosis.
	*Related Images:*	All related Images myxedema_1_030205 myxedema_2_030205 myxedema_3_030205 myxedema_4_030205

© 2001-2010, DermAtlas	*Image Name:*	myxedema_4_030205	*File Type:*	jpg
	*Diagnosis:*	MYXEDEMA, PRETIBIAL / GRAVE DISEASE	*Category:*	lumps & bumps (plaques, nodules, tumors) / Metabolic disorders / cutaneous sign of systemic disease / hyperpigmentation
	*Body Site:*	leg / calf foot	*Age:*	52 years
	*Contributor:*	Bernard Cohen, MD
	*Description:*	symmetric thickening and hyperpigmentation
	*Comments:*	This 52-year-old woman with a 5 year history of goiter and Grave disease developed progressive nontender thickening with exuberant folding of the skin on the shins and tops of the feet. She also had nontender subcutaneous nodules on her upper legs, hands, and arms, diffuse thickening of the soft tissue of the hands and fingers and thickening of the soft tissue of the orbits with bilateral proptosis.
	*Related Images:*	All related Images myxedema_1_030205 myxedema_2_030205 myxedema_3_030205 myxedema_5_030205

© 2001-2010, DermAtlas	*Image Name:*	myxedema_3_030205	*File Type:*	jpg
	*Diagnosis:*	MYXEDEMA, PRETIBIAL / ACROPACHY, THYROID / GRAVE DISEASE	*Category:*	lumps & bumps (plaques, nodules, tumors) / Metabolic disorders / cutaneous sign of systemic disease / hyperpigmentation
	*Body Site:*	hand / finger	*Age:*	52 years
	*Contributor:*	Bernard Cohen, MD
	*Description:*	thickening of the skin, soft tissues and bone, 5 cm nodule on hand with overlying hyperpigmentation
	*Comments:*	This 52-year-old woman with a 5 year history of goiter and Grave disease developed progressive nontender thickening with exuberant folding of the skin on the shins and tops of the feet. She also had nontender subcutaneous nodules on her upper legs, hands, and arms, diffuse thickening of the soft tissue of the hands and fingers and thickening of the soft tissue of the orbits with bilateral proptosis. The nodules showed myxedema, and the diffuse thickening of the hands and feet were consistent with thyroid acropachy.
	*Related Images:*	All related Images myxedema_1_030205 myxedema_2_030205 myxedema_4_030205 myxedema_5_030205