Pretibial myxedema (PTM), an uncommon manifestation of Graves’ disease (GD), is a local autoimmune reaction in the cutaneous tissue. The treatment of PTM is a clinical challenge. We herein report on a patient with PTM who achieved complete remission by multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application for a self-controlled study. A 53-year-old male presented with a history of GD for 3.5 years and a history of PTM for 1.5 years. Physical examination revealed slight exophthalmos, a diffusely enlarged thyroid gland, and PTM of both lower extremities. One milliliter of triamcinolone acetonide (40 mg) was mixed well with 9 mL of 2% lidocaine in a 10 mL syringe. Multipoint intralesional injections into the skin lesions of the right lower extremity were conducted with 0.5 mL of the premixed solution. A halometasone ointment was used once daily for PTM of the left lower extremity until the PTM had remitted completely. The patient’s PTM achieved complete remission in both legs after an approximately 5-mo period of therpy that included triamcinolone injections once a week for 8 wk and then once a month for 2 mo for the right lower extremity and halometasone ointment application once daily for 8 wk and then once 3-5 d for 2 mo for the left lower extremity. The total dosage of triamcinolone acetonide for the right leg was 200 mg. Our experience with this patient suggests that multipoint subcutaneous injections of a long-acting glucocorticoid and topical glucocorticoid ointment application are safe, effective, and convenient treatments. However, the topical application of a glucocorticoid ointment is a more convenient treatment for patients with PTM.
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机译:胫前粘膜水肿(PTM)是Graves病(GD)的罕见表现,是皮肤组织中的局部自身免疫反应。 PTM的治疗是一项临床挑战。我们在此报告了PTM患者,该患者通过多点皮下注射长效糖皮质激素和局部糖皮质激素软膏应用获得了完全缓解,用于自我对照研究。一名53岁的男性,有GD病史3.5年,PTM病史1.5年。体格检查发现轻度眼球突出,甲状腺弥漫性增大以及两个下肢的PTM。在10 mL注射器中,将1毫升丙酮酸曲安奈德(40 mg)与9 mL 2%利多卡因充分混合。用0.5 mL预混溶液对右下肢皮肤病变进行多点病灶内注射。每天一次用一次氟米松软膏治疗左下肢的PTM,直到PTM完全缓解。大约5个月的热疗后,患者的PTM完全缓解了双腿的疼痛,其中包括曲安西龙注射一次,每周一次,连续8周,然后每月一次,连续2个月,一次用于右下肢,氟米松酮软膏,每天一次,连续8周然后一次3-5 d,持续2个月,用于左下肢。右腿曲安奈德的总剂量为200 mg。我们对该患者的经验表明,长效糖皮质激素和局部糖皮质激素软膏的多点皮下注射是安全,有效和方便的治疗方法。然而,对于PTM患者,局部应用糖皮质激素软膏是更方便的治疗方法。
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