Scleromyxedema treatment: a systematic review and update

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Abstract
Importance: Scleromyxedema is a chronic disease with high morbidity and mortality and no definitive therapeutic guidelines.Objective: To review all available data on the efficacy and the safety of the available treatments of scleromyxedema and suggest a possible therapeutic approach.Evidence Review: We performed a systematic literature review in Pubmed/Medline, Embase, and Cochrane collaboration databases, searching for all articles since 1990 on the treatments of scleromyxedema, with no limits on participant age, gender, or nationality.Findings: Ninety‐seven studies were included in this systematic review, of which one prospective, two retrospective, 70 case reports/case series, and 24 letters/correspondence/clinical image. Intravenous immunoglobulin (IVIG) was the most used first‐line therapy based on its efficacy and its generally well‐tolerated nature; most patients require continued treatment to remain in remission. Thalidomide and systemic glucocorticoids were mostly considered as second‐line therapies and were given alone or in association with IVIG. Patients with severe or refractory disease were treated with autologous bone marrow transplantation, melphalan, or bortezomib with dexamethasone.Conclusions and Relevance: Consideration of patient comorbidities, disease distribution, clinician experience, and treatment accessibility is mandatory in every therapeutic approach of scleromyxedema.

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