Published: 2022-10-27

A rare case of elephantiasic pretibial myxedema with secondary cutis verticis gyrata

Phyo Zaw Aung, Pacharee Simsamer, Thamthiwat Nararatwanchai


A 61-year-old man with a history of thyrotoxicosis, diabetes mellitus, hypertension, and dyslipidemia presented to the dermatology outpatient clinic with bilateral non-pitting edema, asymmetrical yellowish-brown plaques, and nodules associated with some areas of hyperpigmentation, Peau’d orange appearance and elephantiasis-like skin lesions over both low legs. It was diagnosed as pretibial myxedema attributed to thyrotoxicosis. Additionally, convoluted folds and deep furrows similar to the cerebral cortical surface were seen on the forehead suggesting secondary cutis verticis gyrata (CVG) and our approach to the patient will be discussed in this case report.



Pretibial myxedema, Thyroid dermopathy, Thyrotoxicosis, CVG

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Mishriki YY. Puzzles in practice. Postgrad Med. 2010;122(2):162-4.

Noppakun N, Bancheun K, Chandraprasert S. Unusual Locations of Localized Myxedema in Graves’ Disease Report of Three Cases. Available at: Accessed on 26 March, 2022.

Ulrich J, Franke I, Gollnick H. Cutis verticis gyrata secondary to acne scleroticans capitis. J Eur Acad Dermatol Venereol. 2004;18(4):499-502.

Jung JS, Lim NK. A Rare Case of Secondary Cutis Verticis Gyrata on the Forehead. J Wound Manag Res. 2020;16(2):113-6.

Fatourechi V. Thyroid dermopathy and acropachy. Best Practice and Research: Clinical Endocrinology and Metabolism. Bailliere Tindall Ltd. 2012;26:553-65.

Shishido M, Kuroda K, Tsukifuji R, Fujita M, Shinkai H. A Case of Pretibial Myxedema Associated with Graves’ Disease: An Immunohistochemical Study of Serum-derived Hyaluronan-associated Protein. J Dennatol. 1995;22(12):948-52.

Fatourechi V. Pretibial Myxedema Pathophysiology and Treatment Options. Am J Clin Dermatol. 2005;6.

Garden JM, Robinson JK. Essential Primary Cutis Verticis Gyrata Treatment with the Scalp Reduction Procedure. Available at: http://archderm. Accessed on 26 March, 2022.

Bilen H, Atasoy M, Akcay G, Akcay M, Capoglu I, Gursan N et al. Images in Thyroidology* Elephantiasic Pretibial Myxedema and Cutis Verticis Gyrata Caused by Graves’ Disease. Thyroid. 2006;6(8):815-6.

Diven DG, Tanus T, Raimer SS. Cutis verticis gyrata. Int J Dermatol. 1991;30(10):710-2.