[Pretibial myxedema after Graves' disease: A differential diagnosis of lymphedema]. / Myxœdème prétibial pseudo-tumoral après une maladie de Basedow : un diagnostic différentiel du lymphœdème.

INTRODUCTION: Pretibial myxedema is a rare manifestation of Graves' disease, and pseudotumoral forms may be confused with lower limb lymphedema. OBSERVATIONS: We reported 3 cases of pretibial myxedema in 2 women and 1 man, aged 72, 66, and 49 years, treated for Graves' disease 3, 25 and 32 years previously. Two patients were active smokers. Lymphedema diagnosis of the lower limbs was suspected in the presence of bilateral pseudotumoral lesions of the feet, toes and ankles and the presence of a Stemmer's sign (skin thickening at the base of the 2nd toe, pathognomonic of lymphedema). Lymphoscintigraphy in one case was normal, not confirming lymphedema. CONCLUSION: Pretibial pseudotumoral myxedema is a differential diagnosis of lower limb lymphedema. This diagnosis is confirmed by questioning the patient about preexisting Graves' disease, the underlying etiology, to decide the appropriate treatment and to encourage cessation of smoking, which is a risk factor for pretibial myxedema.

A case report and differential diagnosis of pruritic pretibial skin lesions.

Pretibial pruritic papular dermatitis (PPPD) is a clinical entity first described in 2006. The etiology is uncertain; however, gentle chronic rubbing is likely to be the reason for the skin reaction. Pretibial pruritic lesions may reflect many different systemic diseases and dermatoses. We present a 61-year-old patient with a 2-year history of pruritic pretibial xerosis, keratotic erythematous to brownish papules, and excoriations. Differential diagnosis excluded papular mucinosis, myxoedema, stasis dermatitis, lichen simplex chronicus, prurigo nodularis, lichen amyloidosis, and lichen planus. Regarding clinical-histological correlation, we confirmed a diagnosis of PPPD.

Stasis Mucinosis: Insights Into Euthyroid Localized Mucinosis.

INTRODUCTION: Stasis mucinosis and obesity-associated lymphedematous mucinosis (OALM) have been described as 2 discrete diagnostic entities. CASE REPORT: A morbidly obese African American man in his late 60s presented to the emergency room with a 3-month history of swelling of both lower extremities and secondary changes suggestive of lymphedema and venous dermatitis. On physical examination, the patient had severe edema with multiple raised areas of verruciform skin changes and varicosities, diffuse induration, erythema, and scaling. He also had an open wound in his left hallux. The skin biopsy found mucinosis. A diagnosis of stasis mucinosis was rendered. He had normal thyroid function test laboratory results. CONCLUSIONS: The authors suggest stasis mucinosis and OALM represent the spectrum of euthyroid mucin depositional disease in varying clinical settings.

[Successful treatment of gangrenous pyoderma with methotrexate in a patient withCrohn's disease]. / Tratamiento exitoso del pioderma grangrenoso con metotrexate en pacientecon enfermedad de Crohn.

Pyoderma gangrenosum (PG) is a neutrophilic, cutaneous-ulcerative, non-infectious dermatosis that occurs in up to 2% of patients with Crohn's disease (CD). Its appearance is usually independent of the clinical course of CD. The most used therapies have been systemic corticosteroids, cyclosporine and biological therapy, which have shown good results. Methotrexate (MTX) is an antimetabolite drug with anti-inflammatory activity characterized by a weekly dosage, a faster onset of action, with a good safety profile related to malignant neoplasms and, above all, a lower cost. It is effective in the induction of remission in patients with CD, however its efficacy in the management of extraintestinal manifestations such as PG is uncertain. We present the case of a young man who comes to the emergency room with an history of chronic diarrhea, weight loss, and fever accompanied by a painful, erythematous nodule, located at the lower extremity compatible with PG in the context of CD. It was initially managed with systemic corticosteroids without improvement. Concomitant therapy with MTX was started with a favorable clinical outcome. In conclusion, the concomitant therapy of systemic corticosteroids and MTX in patients with CD with PG could be an alternative treatment in cases where cyclosporine or biological therapy is not available.

Linear amyopathic dermatomyositis with calcinosis cutis responsive to topical sodium thiosulfate.

A case of a 15-year-old male patient with a 3-year history of linear, segmental amyopathic dermatomyositis with calcinosis cutis is presented. The calcinosis was recalcitrant to treatment with topical steroids and hydroxychloroquine. Topical 10% sodium thiosulfate use for 8 weeks resulted in improvement. The use of topical sodium thiosulfate for patients in whom surgical extraction is not an option is detailed.

Linear morphea overlying site of previous lichen aureus in a pediatric patient.

Lichen aureus is a pigmented purpuric dermatosis that tends to occur on the lower extremities, and linear morphea is an inflammatory disease of the dermis and subcutaneous fat that leads to a scarlike induration. We present a pediatric case of linear morphea developing in the same anatomic distribution as prior lichen aureus. Due to the possible progression of lichen aureus to morphea described herein and the difficulty in diagnosing early morphea, close follow-up may be considered for pediatric patients who present with this pigmented purpuric dermatosis.

Tratamiento exitoso del pioderma grangrenoso con metotrexate en paciente con enfermedad de Crohn / Successful treatment of gangrenous pyoderma with methotrexate in a patient with Crohn's disease

El pioderma gangrenoso (PG), es una dermatosis neutrofílica, cutáneo-ulcerativa, no infecciosa, que ocurre hasta en un 2% de los pacientes con enfermedad de Crohn (EC). Su aparición suele ser independiente del curso clínico de la EC. Las terapias más utilizadas han sido los corticoides sistémicos, la ciclosporina y la terapia biológica, los cuales han mostrado buenos resultados. El Metotrexate (MTX) es un fármaco antimetabolito con actividad antiinflamatoriaque se caracteriza por una dosificación semanal, un inicio de acción más rápida, con buen perfil de seguridad relacionado con neoplasias malignas y sobretodo un menor costo. Posee eficacia en la inducción de la remisión en pacientes con EC, sin embargo su eficacia en el manejo de manifestaciones extraintestinales como el PG es incierta. Presentamos el caso de un varón joven que acude a urgencias por diarrea crónica, pérdida de peso, y fiebre acompañado de un nódulo doloroso, eritematoso, situado a nivel pretibial compatible con PG en el contexto de EC. Fue manejado inicialmente con corticoides sistémicos sin mejoría. De tal forma, se inició terapia concomitante con MTX con respuesta clínica y analítica favorable. En conclusión, la terapia concomitante de cortiocoides sistémicos y MTX en pacientes con EC con PG podría suponer un tratamiento alternativo al no contar con disponibilidad de ciclosporina o terapia biológica en nuestro medio.

Pyoderma gangrenosum (PG) is a neutrophilic, cutaneous-ulcerative, non-infectious dermatosis that occurs in up to 2% of patients with Crohn's disease (CD). Its appearance is usually independent of the clinical course of CD. The most used therapies have been systemic corticosteroids, cyclosporine and biological therapy, which have shown good results. Methotrexate (MTX) is an antimetabolite drug with anti-inflammatory activity characterized by a weekly dosage, a faster onset of action, with a good safety profile related to malignant neoplasms and, above all, a lower cost. It is effective in the induction of remission in patients with CD, however its efficacy in the management of extraintestinal manifestations such as PG is uncertain. We present the case of a young man who comes to the emergency room with an history of chronic diarrhea, weight loss, and fever accompanied by a painful, erythematous nodule, located at the lower extremity compatible with PG in the context of CD. It was initially managed with systemic corticosteroids without improvement. Concomitant therapy with MTX was started with a favorable clinical outcome. In conclusion, the concomitant therapy of systemic corticosteroids and MTX in patients with CD with PG could be an alternative treatment in cases where cyclosporine or biological therapy is not available.

Bullous lupus erythematosus with an erythema gyratum repens-like pattern.

Bullous lupus erythematosus is a rare clinical form of lupus. The diagnosis is challenging and involves the exclusion of other subepidermal bullous dermatoses. We present a 21-year-old woman with erythematosus, polycyclic plaques with vesiculobullae along the periphery, creating an erythema gyratum repens-like pattern on acral regions. The cutaneous biopsy, analytical, and autoimmune studies support the diagnosis of systemic lupus erythematosus. Dapsone and glucocorticosteroids were given with prompt resolution of the lesions within two weeks. To our knowledge this is the first case of bullous lupus erythematosus with this atypical acral presentation.

Oxalosis in a Patient with Livedo Reticularis.

A 27-year-old man with terminal renal failure requiring peritoneal dialysis for the past 2 years was referred to the dermatologist for evaluation of red violaceous macular skin lesions consistent with livedo reticularis. These lesions had appeared suddenly on his legs (Figure 1). He had first experienced recurrent nephrolithiasis at the age of 14. Results from urine analysis and abdominal ultrasound revealed chronic kidney failure. Because the patient had a sister with similar findings, primary hyperoxaluria (PH) was suspected and genetic testing was performed in all members of his family. The results confirmed PH type 1 (PH1) in both our patient and his sister, who had died 8 years after the establishment of the diagnosis. A biopsy of the livedo reticularis lesions revealed deposits of a yellowish brown crystalline material within the lumen and the media of medium vessels in the hypodermis associated with a histiocytic giant cell reaction (Figure 2a). There was no evidence of extravascular calcium deposition in the sections examined. The deposits were intensely birefringent under polarized light, and classic speculated crystals of oxalate salts were observed (Figure 2b). No focal epidermal or superficial dermal necrosis was seen. On the basis of the histopathologic findings, the diagnosis of oxalate crystal-induced vascular disease was established. The patient subsequently developed complications including pancreatitis and peritonitis. He underwent hemodialysis until a combined liver-kidney transplant could be performed.