Pretibial myxoedema
There is an infiltration of the dermis with mucin giving rise to thickening and oedema of the skin particularly on the shins, due to excess hyaluronic acid deposition in Graves' disease. The hair follicle orifices are patulous over the nodules producing a peau d'orange appearance. There is hypertrichosis. It may not appear until after treatment of the hyperthyroidism.
© Photographs courtesy of St Mary's Hospital.
