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Multipoint subcutaneous injection of long-acting glucocorticid as a cure for pretibial myxedema.

BACKGROUND
Pretibial myxedema (PM) is an uncommon and characteristic manifestation of Graves' disease (GD), with local autoimmune reaction in cutaneous tissue. The treatment of PM is a clinical challenge. We herein report a patient with PM who achieved complete remission by multipoint subcutaneous injection of long-acting glucocorticid.


SUMMARY
A 38-year-old man presented with an 18-month history of GD and a 1-year history of PM. Physical examination revealed mildly prominent eyes, diffuse enlargement of the thyroid gland, and PM of both lower extremities. The patient was treated with triamcinolone acetonide by multipoint subcutaneous injections in a combined dose of 20 mg in each lower extremity administered every 25-28 days. The injection was started from the borderline of the lesions and normal skin by selecting 4 to 5 points per leg for each course and then moving to other parts in subsequent courses of treatment. The depth of needle insertion was 0.5-1.0 cm. The patient's PM achieved complete remission in both lower extremities after an approximately 6-month period that included seven courses of treatment with a total dosage of 280 mg triamcinolone acetonide.


CONCLUSIONS
Our experience with this patient suggests that multipoint subcutaneous injection of long-acting glucocorticid is a safe, effective, and convenient treatment of PM in patients with GD.