Lichen Myxedematosus: Case Report and Review of Literature

March 2020 | Volume 19 | Issue 3 | Case Reports | 320 | Copyright © March 2020


Published online February 5, 2020

Amaris Geisler , Mojgan Hosseinipour , Nikki S. Vyas , Robert Phelps , Charles Gropper , Cindy Hoffman

aMedical Student, CUNY School of Medicine, New York, NY bResident Physician, St. Barnabas Hospital, Department of Dermatology, Bronx, NY cResident Physician, Department of Pathology, Mount Sinai Medical Center, New York, NY dDirector of Dermatopathology, Mount Sinai Medical Center, New York, NY eChief of Dermatology, St. Barnabas Hospital, Bronx, NY fProgram Director, St. Barnabas Hospital, Department of Dermatology, Bronx, NY

papillary dermis.13 Lastly, the nodular form, also known as atypical tuberous myxedema of Jadassohn Dosseker, presents with multiple nodules on the limbs and trunk with absent or mild papular eruption.2,8 Treatment is not required for asymptomatic, localized LM.6 Interestingly, a case study of two morbidly obese women demonstrated a correlation of weight loss with complete clinical and histopathologic resolution of cutaneous lesions.9

The third subset of LM includes atypical or intermediate forms that do not meet criteria for scleromyxedema or localized LM. This subset includes 1) scleromyxedema without monoclonal gammopathy, 2) localized LM with monoclonal gammopathy and/or systemic symptoms, 3) localized LM with mixed features of the five subtypes, and 4) not well specified cases. The course of atypical forms is unpredictable.2,9

CONCLUSION

This case is unusual because of the multiple morphologies seen clinically, which is a rare presentation. It is important to distinguish the chronic, disabling course of scleromyxedema, associated with systemic and fatal manifestations, from the treatment-independent localized form of LM.2 Topical application of corticosteroids, pimecrolimus, or tacrolimus may be of some benefit, however, spontaneous resolution is most common, even in the setting of HIV infection.2 With the revised diagnostic criteria, mean time from primary symptoms to diagnosis has decreased from 41.6 to 10 months.4 Further research is needed to adequately diagnose and treat LM.

DISCLOSURES

The authors declare that they have no relevant conflicts of interest to disclose.

REFERENCES

  1. Hadj I, Gallouj S, Meziane M, Mernissi FZ. Discrete papular lichen myxedematosus: a rare entity or an under-diagnosed disease? The Pan African Medical Journal. 2014; 19: 180.
  2. Rongioletti F, Rebora A. Updated classification of papular mucinosis, lichen myxedematosus, and scleromyxedema. J Am Acad Dermatol. 2001; 44(2): 273-281.
  3. Christman MP, et al. Papular mucinosis, or localized lichen myxedematosis (LM) (discrete papular type). Dermatol Online J. 2017;23(12):8.
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  11. Tam CC, Meier MJ. Discrete papular lichen myxedematosus with an unusual segmental presentation. Acta Dermatovenerol Croat. 2014;22(3):224-226.
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AUTHOR CORRESPONDENCE