How is pretibial myxedema treated?

Most patients who develop mild pretibial myxedema do not require any specific treatment. Some patients who develop moderate pretibial myxedema may need to be treated if they develop problems with pain, disfigurement, or impaired motion of the feet or ankles. In such cases, treatment usually focuses on the direct application of glucocorticoids. Glucocorticoids are steroid hormones that are similar to a hormone produced by the adrenal glands called cortisol. They help to reduce inflammation by blocking the movement of white blood cells that infiltrate tissues. A glucocorticoid in a cream base can usually be applied directly to any areas of thickened skin. For the sake of convenience, this is usually done at bedtime so that areas of thickened skin covered with the cream base can be bound with plastic wrap. This may help to increase the penetration of the glucocorticoid. If applications are continued on a regular basis, gradual improvement in appearance and function may be noted over the course of several weeks. The effectiveness of treatment may be increased if compression stockings are worn during the daytime to limit the accumulation of fluid in the lower legs and feet. In rare cases of severe myxedema, surgery with skin grafting may be considered to remove enlarging lesions that do not respond to applications of glucocorticoids.