Pretibial Myxedema (Graves' Dermopathy)

What is pretibial myxedema?

Pretibial myxedema, also known as Graves’ dermopathy, is a form of Graves’ disease that affects your skin. The condition causes carbohydrates and sugar compounds (glycosaminoglycans or mucopolysaccharides) to build up deep within your skin and tissue. Pretibial myxedema affects your lower legs and causes lumps, scaling plaques and swelling (edema).

What do pretibial and myxedema mean?

“Pretibial” refers to the front (anterior) of your tibia. This is your shin bone. You can find your shin bone underneath your knee. “Myxedema” means swelling of the tissues underneath your skin.

Who does pretibial myxedema affect?

Pretibial myxedema can affect anyone, but it’s most common among people who:

• Have Graves’ disease.
• Have a thyroid condition (hypothyroidism or hyperthyroidism).
• Have severe eye disease.
• Are between the ages of 40 and 60.
• Are women or people assigned female at birth (AFAB).

What are the types of pretibial myxedema?

There are four different types of pretibial myxedema that include:

• Diffuse: The most common type of pretibial myxedema, in which non-pitting edema of your leg occurs.
• Plaque: Raised, thick and scaly plaques form on your skin in addition to non-pitting edema.
• Nodular: Nodules (firm lumps) form in addition to non-pitting edema.
• Elephantiasic: The rarest form of pretibial myxedema, in which lymphatic fluid builds up under your skin, creating a warty appearance.

What are the symptoms of pretibial myxedema?

Symptoms of pretibial myxedema include:

• Swelling, where your skin looks and feels larger than it did a day ago.
• Firm lumps underneath your skin.
• Areas of your skin become thick and scaly (plaques).
• Skin and hair follicles have a shiny, waxy texture like an orange peel.
• Skin changes color, from yellow and orange to brown and red to purple.
• Increased sweating or excessive hair growth in affected areas.
• Sore or itchy skin.

Early symptoms of pretibial myxedema include a lump on your skin that’s firm. This lump can change in size or merge with other lumps.

Where do symptoms of pretibial myxedema affect my body?

Pretibial myxedema symptoms most often affect:

• Lower legs.
• Feet.
• Shins.

Symptoms that affect the face may be the result of Graves’ disease or a thyroid condition.

What causes pretibial myxedema?

A buildup of sugar compounds (glycosaminoglycans or mucopolysaccharides) in the dermis and hypodermis layers of your skin and tissue cause pretibial myxedema. The exact reason for these compounds to buildup in your skin is unknown, but research suggests the cause may be from:

• An autoimmune response: Your immune system tells your body to activate thyroid hormone antibodies that make your cells produce too many glycosaminoglycans.
• T lymphocyte activation: T lymphocytes are cells in your immune system. These cells enter your skin tissues to release messenger proteins (cytokines) that tell your cells to produce too many glycosaminoglycans.
• Injury response: If you had an injury in your lower legs (pretibial area), immune cells and proteins could cluster at the site of your injury if you don’t have enough thyroid hormones (hypothyroidism). Your thyroid hormones regulate activity in your tissues to prevent compound buildup.

How is pretibial myxedema diagnosed?

A healthcare provider will diagnose pretibial myxedema after taking a complete medical history and performing a physical exam, where they’ll review your symptoms. To confirm a diagnosis, your provider will offer a blood test to check your thyroid levels. A skin biopsy can detect the condition and may detect high levels of glycosaminoglycans in your skin.

How is pretibial myxedema treated?

Treatment for pretibial myxedema isn’t always necessary, as most of the symptoms are cosmetic. But treatment options are available and include:

• Compression socks or stockings to decrease swelling.
• Topical creams or ointments to prevent itching and swelling.
• Oral and topical medications and injections to minimize the lumps underneath your skin or reduce cosmetic symptoms.
• Treatment for Graves’ disease or a thyroid condition.
• Plasmapheresis: A process that removes plasma (the liquid part of your blood) from the cells in your blood. During this process, your red and white blood cells and platelets return back into your body in a new fluid solution.

Surgery to remove the lumps underneath your skin is successful but not recommended, as there’s a high risk of the lumps returning after your skin heals. This happens because your body views your surgery site as an injury, and pretibial myxedema is common at sites of injuries.

What medications treat pretibial myxedema?

Your provider might offer one of the following medications to relieve your symptoms of pretibial myxedema:

• Corticosteroids: A topical medication you can rub on your skin that can treat swelling, inflammation and itchiness.
• Pentoxifylline: An oral medication that improves blood flow in your legs.
• Octreotide: An injectable medication that can reduce the size of the lump underneath your skin.
• Rituximab: An infusion medication that helps your antibodies work more efficiently.
• Intravenous immunoglobulin: A medicine given through an IV into your vein that helps antibodies in your immune system work better.

Before taking new medications, talk to your provider about the potential side effects, how often you should take the medicine and the current medications you take to avoid drug interactions.

How soon after treatment will I feel better?

The length of time that you’ll have symptoms of pretibial myxedema varies based on the severity of your condition. It could take a few weeks to a few months for your symptoms to go away with treatment. Without treatment, it could take a few years for the condition to go away on its own. The condition could come back after it goes away if you injure the lower part of your legs.

How can I prevent pretibial myxedema?

There’s no sure way to prevent pretibial myxedema, but you can reduce your risk of acquiring the condition by:

• Not smoking tobacco products.
• Receiving treatment to manage conditions that affect your thyroid function.
• Wearing compression socks or stockings.

What can I expect if I have pretibial myxedema?

A prognosis, or outcome, for pretibial myxedema is good. The condition doesn’t require treatment if your symptoms are only cosmetic. The condition will clear up on its own if you have a mild case. If you have a severe case of pretibial myxedema, you still have a good prognosis, but it could take several years before the condition goes away completely.

When should I see my healthcare provider?

There’s a risk that pretibial myxedema could come back after it goes away. This happens most often if you injure the lower part of your legs. Talk to your provider if your symptoms come back after they’ve gone away. If you experience symptoms of pain or severe itchiness, visit your provider.

What questions should I ask my doctor?

• Can I wear compression socks to help pretibial myxedema?
• Do I need treatment for pretibial myxedema?
• Do I have an underlying thyroid condition that caused my symptoms?
• How can I take care of my skin affected by pretibial myxedema?

What is the difference between pretibial myxedema and erythema nodosum?

Both pretibial myxedema and erythema nodosum are conditions that affect your skin, most often the skin on your lower legs, located below your knee. The symptoms are different for each condition:

• Pretibial myxedema causes swelling and plaques of shiny, thick and scaly skin.
• Erythema nodosum causes swelling and small, painful bumps on your skin.

A note from Cleveland Clinic

Pretibial myxedema is a condition that doesn’t usually cause symptoms that need treatment. The condition will go away on its own, but treatment is available if the physical symptoms of the condition are bothersome. Wearing compression socks or stockings can help reduce swelling to make you more comfortable. Talk to your provider if you experience pain or severe itching in your lower legs.