Herskovitz Ingrid, Hughes Olivia, MacQuhae Flor, Kirsner Robert S
Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, FL.
Wounds. 2017 Mar;29(3):77-79.
The authors report a case of pretibial myxedema (PTM) masquerading as a venous leg ulcer to alert wound care clinicians to this diagnostic possibility. Pretibial myxedema is a localized form of mucin cutaneous deposition characterized by indurated plaques most commonly on anterior legs. It is more likely to present in patients with Graves' disease, but it can be found in euthyroid patients as well. The physiopathology of PTM is complex, and there is an accumulation of highly hydrophilic glycosaminoglycans in the dermis. Minimal morbidity is associated with PTM, but the pruritus related to mucin deposition can be intense. The skin around venous leg ulcers and the skin changes related to PTM can have a similar clinical presentation, which may be a reason PTM is under-recognized.
作者报告了一例伪装成下肢静脉溃疡的胫前黏液性水肿（PTM）病例，以提醒伤口护理临床医生注意这种诊断可能性。胫前黏液性水肿是一种局限性的黏蛋白皮肤沉积形式，其特征是通常在前腿部出现硬结性斑块。它更常见于患有格雷夫斯病的患者，但也可见于甲状腺功能正常的患者。PTM的生理病理学很复杂，真皮中会积累高度亲水的糖胺聚糖。PTM的发病率较低，但与黏蛋白沉积相关的瘙痒可能很严重。下肢静脉溃疡周围的皮肤以及与PTM相关的皮肤变化可能具有相似的临床表现，这可能是PTM未被充分认识的一个原因。
