LOCALIZED PRETIBIAL MYXEDEMA: REPORT OF TWO CASES TREATED WITH HYDROCORTISONE BY LOCAL INJECTION

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Abstract
The dose of medication used was 6.25 mg to 12.5 mg given directly into the lesions. They were from 2x3 cm to 3x3 cm in diameter and disappeared in 2 weeks. Review of the literature would seem to relate the pathogenesis of localized pretibial myxedema (LPM) to progressive exophthalmos. LPM tissue and retrobulbar tissue from experimentally produced exophthalmos are similar. In some instances both tissue contain increased numbers of mast cells, increased quantities of hyaluronic acid, chondroitin sulfate, and water. The occurrence of progressive exophthalmos and LPM in thyrotoxicosis may result from local tissue unresponsiveness to thyroid hormone. Since local injection of hydrocortisone early in the development of LPM results in regression of the lesion, retrobulbar injection of hydrocortisone early in the course of progressive exophthalmos may be of benefit. However, all are not agreed that this relationship in pathogenesis of the 2 conditions is clear-cut; therefore additional study of tissue from LPM and from retrobulbar tissue of progressive exophthalmos remains to be done.