Pretibial myxedema

This is a misnomer and it is seen in primary toxicosis (in Grave's disease with exopthalmos only). It is usually symmetrical. The earliest stage is shiny red plaque of thickened skin with coarse hair, which may be cyanotic when cold. In severe cases, the skin of the whole leg below knee is involved, together with that of foot and the ankle and there may be clubbing of fingers and toes (thyroid acropachy)