What Is Graves’ Dermopathy?

Graves’ dermopathy, also called pretibial myxedema, is a rare skin condition that develops in some people with Graves’ disease, which is an autoimmune thyroid disease. Graves' disease occurs when your immune system attacks your thyroid gland and cause it to produce more thyroid hormones you need. Symptoms of Graves' dermopathy include swollen, red skin that’s most often on the shins. 

The thyroid gland sits in the front of your neck. It regulates many hormones and systems in your body. When it produces too much thyroid hormone, it’s called hyperthyroidism. Graves’ disease is autoimmune hyperthyroidism.

This article looks at the symptoms and possible causes of Graves’ dermopathy plus how it’s diagnosed and treated.

Graves’ Dermopathy Symptoms

In Graves’ dermopathy, the skin is:

• Red or brown
• Inflamed
• Thickened
• Of an “orange peel” texture
• Sometimes itchy
• Painful (less often)

It can affect your: 

• Shins (most often)
• Ankles
• Tops of the foot
• Knees
• Elbows
• Upper back
• Neck
• Forehead
• Ears

It usually affects both sides of the body in a symmetrical pattern, but it sometimes appears only on one side.

About 96% of Graves’ dermopathy cases are in people who have Graves’ ophthalmopathy, also referred to as Graves' orbitopathy, which can cause bulging eyes, eye pain, and vision impairment.

Sometimes, Graves’ dermopathy can be a sign of undiagnosed Graves’ disease. Common Graves’ disease symptoms include:

• Heat intolerance
• Tremor
• Rapid heartbeat (tachycardia)
• Anxiety
• Extreme fatigue
• Unintended weight loss, possibly with increased appetite
• Frequent bowel movements
• Shortness of breath
• Goiter (swelling in the front of the neck)

Causes

Graves’ dermopathy is believed to be part of the autoimmune reaction in Graves’ disease.

In this disease, the immune system targets cells that bind to thyroid-stimulating hormone (TSH). These cells sometimes appear in the skin, so the immune system attacks them there.

Progression

Typically, Graves’ dermopathy shows up in advanced thyroid disease. This most often means the disease has been untreated or under-treated. 

Symptoms of hyperthyroidism usually develop first. Later, Graves’ ophthalmopathy may appear, then Graves' dermopathy.

In about 20% of cases, people with Graves’ dermopathy eventually develop thyroid acropachy, which is soft tissue swelling and clubbing of fingers and toes.

Diagnosis

If you've been diagnosed with Graves’ disease, especially Graves' ophthalmopathy, your doctor may diagnose Graves’ dermopathy on sight through a physical exam. However, tests can confirm the diagnosis.

In samples taken through biopsy, the lab will look for:

• Mucin (a protein that makes up a large portion of mucus)
• Glycosaminoglycans (GAGs, compounds that help make up connective tissues)
• Accumulation of fluid in the hands and feet
• Abnormal collagen fibers

If your doctor suspects Graves’ dermopathy but you’ve not been diagnosed with Graves’ disease, they may also order blood tests to check your thyroid hormone levels, measure TSH, and look for thyroid antibodies.

Treatment

Treating the underlying thyroid disease doesn’t usually help clear up skin symptoms. If Graves’ dermopathy isn’t itchy or painful, it may not need to be treated. However, you may choose to treat it because you don’t like how it looks.

Treatment options include:

• Topical or injected corticosteroids
• Physical therapy
• Surgery
• Medications, including Sandostatin (octreotide) and Trental or Pentoxil (pentoxifylline)
• Immunoglobulin treatment (a treatment made of antibodies given intravenously)
• Plasmapheresis (a procedure that swaps unhealthy plasma in your blood for healthy plasma)

In studies, 70% of mild cases went into partial or complete remission without treatment. With treatment, 58% of severe cases went into partial or complete remission.

Freqeuently Asked Questions

What Causes Graves' Dermopathy?

The autoimmune target of Graves' disease is cells that bind to TSH. Most of these cells are in the thyroid gland, but they are sometimes found in your skin as well. That causes the immune system to launch an attack on those cells.

Can Pretibial Myxedema be Cured?

Pretibial myxedema can't be "cured" in that it's certain you'll never have it again. However, most cases do go into remission on their own. If yours doesn't, then treatment can help clear it up.

What is Thyroid Storm?

Thyroid storm is a rare but life-threatening complication of hyperthyroidism. It's caused by uncontrolled hyperthyroidism or a stressor, such as trauma, heart attack, or infection. Symptoms include agitation and confusion, shaking, sweating, bulging eyeballs, pounding heart, diarrhea, changes in consciousness, goiter, and high blood pressure. Thyroid storm requires emergency medical attention.

What Are Thyroid Hormones and What Do They Do?

The hormones produced by the thyroid gland are triiodothyronine (T3) and thyroxine (T4). T3 is the active form. It helps regulate critical bodily functions, including your heart rate, breathing, and body temperature. T4 is converted into T3 by various tissues, including the liver and brain. That way, the right amount of T3 is in the right place at the right time.

Summary

Graves’ dermopathy is a rare skin condition experienced by some people with Graves’ disease. It’s usually present on both sides and most common on the shins or the tops of the feet. Doctors may diagnose it based on a previous diagnosis of Graves’ disease and the condition's distinct appearance. They may also order a skin biopsy and blood tests. Several treatment options are available, including corticosteroids, physical therapy, surgery, and medications.

A Word From Verywell

If you suspect Graves’ dermopathy, have your doctor look at it. Timely diagnosis and treatment is especially important if you have not been diagnosed with Graves’ disease but have other symptoms that suggest it.

If you have symptoms of Graves' dermopathy, know that treatments are available and a large majority of cases go into remission. You don’t have to live with the symptoms.