Endocrine Unit, Department of Clinical Sciences and Community Health, University of Milan, Fondazione Cà Granda IRCCS, Milan, Italy.
Thyroid. 2013 May;23(5):626-32. doi: 10.1089/thy.2012.0429.
Pretibial myxedema (PTM) is a rare extrathyroidal manifestation of Graves' disease that requires treatment when the clinical picture is markedly evident. In addition to topical treatment with steroid ointments, there have been previous reports of subcutaneous injections of steroids. This procedure may cause nodular degeneration of the skin due to fat atrophy when standard needles are used. In the present study, we have tried a novel modality of treatment of PTM by injecting a solution of dexamethasone in the subcutaneous tissue using needles employed for mesotherapy. These needles are ≤4 mm long and deliver the medication within the dermis or the first layer of the subcutaneous fat. We have treated five patients, four with diffuse and one with elephanthiasic PTM. We utilized multiple injections of a solution of dexamethasone, lidocaine, and saline in the PTM plaque and in the pretibial area, both in the PTM plaque and in the area surrounding the lesions, once a week for three consecutive weeks. Two patients with a more severe form of PTM underwent another two cycles four to six weeks after initial treatment. Patients were studied before and after treatment by clinical assessment and ultrasound of the pretibial skin. The treatment was well-tolerated, with only moderate pain upon injection of the solution. One month after treatment, all patients showed improvement of PTM at clinical assessment and a reduction of the thickness of the lesions at ultrasound of ∼15%, involving mostly the dermis. Moreover, all patients reported amelioration of the leg appearance. The present study, although preliminary, shows that intralesion steroid injection with mesotherapy needles in PTM is effective and well tolerated, and does not cause undesired long-term modifications of the skin. More studies are warranted to standardize such treatment in larger groups of patients.
胫前黏液水肿（PTM）是 Graves 病的一种罕见的甲状腺外表现，当临床表现明显时需要治疗。除了局部使用类固醇软膏外，以前还有报道使用类固醇皮下注射。当使用标准针头时，这种方法可能会由于脂肪萎缩而导致皮肤结节性变性。在本研究中，我们尝试了一种通过使用中胚层疗法的针头将地塞米松溶液注入皮下组织来治疗 PTM 的新方法。这些针头的长度≤4 毫米，将药物输送到真皮或皮下脂肪的第一层。我们已经治疗了五名患者，四名患者为弥漫性 PTM，一名患者为象皮肿性 PTM。我们在 PTM 斑块和胫前区域、PTM 斑块和病变周围区域的多个部位，每周一次，连续三次，用含有地塞米松、利多卡因和生理盐水的溶液对 PTM 斑块进行多点注射。两名 PTM 病情较重的患者在初始治疗后四到六周又进行了两个周期的治疗。在治疗前后，通过临床评估和胫前皮肤的超声检查对患者进行了研究。治疗耐受性良好，仅在注射溶液时会有中度疼痛。治疗一个月后，所有患者在临床评估中均显示 PTM 改善，超声显示病变厚度减少了约 15%，主要累及真皮。此外，所有患者都报告腿部外观得到改善。本研究虽然初步，但表明中胚层疗法针头内注射类固醇治疗 PTM 有效且耐受性良好，不会导致皮肤产生不良的长期改变。需要进一步的研究来规范在更大的患者群体中使用这种治疗方法。
