Myxedema circumscriptum thyrotoxicum; report of two cases and remarks on its pathogenesis and treatment.

UNDER such names as “myxedema circumscriptum thyrotoxicum”, “localized solid edema of the extremities in association with exophthalmic goiter” and “localized pretibial myxedema” are described cutaneous lesions of myxedematous appearance observed in patients with Graves-Basedow disease. Clinically these lesions are characterized by patches or cutaneous nodules, usually of very definite outlines, which as a general rule appear symmetrically on the anterior surface of both legs or on the dorsal surface of the feet (Figs. 1 and 2). Their size is variable; in some cases they are scarcely apparent, whereas in others they cover all of the distal segment of the inferior extremities. The overlying skin is erythematous, cyanotic or yellowish-white and the follicles are often dilated, giving an orange-skin or pig-skin appearance. Palpation reveals a swelling which does not pit on pressure (non-pitting edema), as well as hypothermia and the absence of perspiration. The lesions are always painless; some patients compl...