IN THE NAME OF ALLAH THE MOST GRACIOUS, THE MOST COMPASSIONATE

1. IN THENAME OF ALLAHTHE MOST GRACIOUS, THE MOSTCOMPASSIONATE

2. BY CASE PRESENTATION Halaabdel-aziz

3. A 45 year old female patient Presented by: Skin lesion of 5 month duration on both legs, increasing slowly in size.

4. +ve history of diabetes and hypertension. Also receives anti-thyroid drugs one year ago.

5. EXAMINATION: • * Symmetrical hyperpigmented plaques on the lower aspect of both legs. • * The lesions are indurated with well defined border.

6. Examinations of: Hair & nail: Nothing abnormal detected M.M:

8. There is exophthalmos of both eyes.

9. Also , there is enlargement of thyroid gland.

10. CLINICAL D.D: • Pretibialmyxedema. • Lymphedema. • Stasis dermatitis. • Lipodermatosclerosis

11. INVESTIGATIONS: • Thyroid funtion tests. • Free (T3) : 3.2 pg\ml. (2.2 – 2.7) • Free (T4) : 0.8 ng\dl. (0.7 – 2.0) • T.S.H : 0.01 ulu\ml. (0.4 – 4.1)

12. U\S of thyroid gland. • Enlarged both thyroid lobes and the isthmus. • Multiple well defined solid nodular lesions at both lobes and isthmus. • No detectable retrosternal extension. • No detectable calcification or cervical L.N.

13. Skin biopsy. • Skin biopsy was taken from the lesion in RT leg for • Histopathological examination

14. Widely separated collagen bundles

15. There are cavities between collagen bundles

16. Mucin deposits on thick collagen.

17. Diagnosis ?

19. PRETIBIAL MYXEDEMA

20. (After 10 days of ttt of topical steroid under occlusive dressing.)

21. PRETIBIAL MYXEDEMA This is an uncommon complication of Grave's disease, occurring in 1-4% of patients. There is a diffuse, non-pitting edema and thickening of the skin usually on the anterior aspect of the lower legs. Advanced cases may involve the upper trunk, upper extremities, face, neck, and ears. It occasionally occurs in non-thyrotoxic Grave's disease, autoimmune thyroiditis, and stasis dermatitis. The serum contains circulating factors which stimulate fibroblasts to increase synthesis of glycosaminoglycans.

22. Female patient aged 62 years presented by: Numerous nodules in both legs History of recurrent cellulites

24. Multiple nodules on lower aspect of both legs varying in size, firm in consistancy

25. +ve history of diabetes

26. Possible clinical diagnosis was: Mucinosis Psudoelephantiasis

27. Investigations *C.B.C: Anemia * US : hepatomegaly * Biopsy for : Histopathological examinations

28. * Mucin deposits bet collagen fibers. * Plumb shaped fibroblast. * Perivascular lymphocytic inilterate

30. Mucin deposits between collagen bundles

32. Papularmucinosis 2ry to lymphedema

33. (After 10 days of ttt of topical steroid under occlusive dressing.)

34. Cutaneous mucinosis * It is a term used to describe a group of diseases characterised by abnormal deposits of mucin in the dermis.

35. Classification of cutaneous mucinosis: Primary Secondary

36. Primary Systemic and cutaneous Systemic: 1-Papular mucinosis: * Papular, plaque and nodular variants. * Sclerotic variant 2-Myxoedema * Generalised * Pretibial 3-Mucopolysaccharoidosis syndromes

37. Cutaneous: 1-Follicular mucinosis(alopecia mucinosa) * Benign asymptomatic or idiopathic * Malignant associated with reticulosis 2-Cutaneous mucinosis of infancy 3-Cutaneous focal mucinosis 4-Scleroderma of Buchcke

38. Secondary Systemic: Associated with collagen disease like lupus erythematosus & dermatomyositis.

39. Cutaneous: 1-Associated with other dermatoses: *Jessner lymphocytic infilteration *Reticular erythematousmucinosis *Plaque-like cutaneous mucinosis *Degos disease *Granulomaannulare 2-Secondary to ultraviolet radiation and PUVA therapy 3-Associated with cutaneous tumours: -Basal cell carcinoma -Tumours of sweat gland origin -Neural tumour -Pyogenicgranuloma

40. THANK YOU