What are the other Names for this Condition? (Also known as/Synonyms)

• Atypical Tuberous Myxedema of Jadassohn Dosseker
• Nodular Lichen Myxoedematosus
• Nodular-type Papular Mucinosis

What is Nodular Lichen Myxedematosus? (Definition/Background Information)

• Nodular Lichen Myxedematosus is the localized form of lichen myxedematosus (LM), which is a rare skin abnormality characterized by mucin deposition in the skin
• Nodular Lichen Myxedematosus is a very uncommon condition that is characterized by the presence of multiple skin-colored nodules beneath the skin, particularly on the limbs and trunk region. The condition is frequently seen in young adults
• Unlike other localized forms of lichen myxedematosus, in the nodular-type, the small papular eruptions on skin are relatively mild or even absent
• The exact cause of development of Nodular Lichen Myxedematosus is currently unknown. It may be due to an abnormal immune system in the body
• Nodular Lichen Myxedematosus is usually diagnosed by a skin biopsy. Following its diagnosis, if necessary, a treatment of the condition is undertaken. The treatment measures may include light therapy, use of topical creams, dermabrasion, and intralesional injections
• The prognosis of Nodular Lichen Myxedematosus is usually good, since only skin manifestations are observed. However, unlike other localized forms of lichen myxedematosus, the nodular-type is not reportedly self-limiting

Who gets Nodular Lichen Myxedematosus? (Age and Sex Distribution)

• Nodular Lichen Myxedematosus is a very rare skin condition that is usually diagnosed in the age range of 18-48 years (average age 30 years). Occasionally, the condition may be seen in young children
• Studies have shown that Nodular Lichen Myxedematosus occurs in younger/lower age groups, when compared to the discrete and acral forms of lichen myxedematosus
• Both males and females are affected
• All racial and ethnic groups are affected and no predilection is reported

What are the Risk Factors for Nodular Lichen Myxedematosus? (Predisposing Factors)

• No risk factors have been presently identified for Nodular Lichen Myxedematosus
• Some localized forms of lichen myxedematosus are associated with exposure to toxic substances, such as certain oils, and contaminated L-tryptophan (an amino acid)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Nodular Lichen Myxedematosus? (Etiology)

• The exact cause of Nodular Lichen Myxedematosus formation is generally unknown. It may be due to an abnormal immune function that typically involves the skin (not a systemic condition)
• It is a non-contagious condition that cannot spread from one individual to another. This means that one cannot get Nodular-type Lichen Myxedematosus through direct contact or from being in close proximity to an individual having the condition

What are the Signs and Symptoms of Nodular Lichen Myxedematosus?

The signs and symptoms of Nodular Lichen Myxedematosus may include:

• Presence of several subcutaneous nodules ranging from 5 mm to 1 cm in size; some are larger in size
• The nodules are firm and elevated (project from the skin surface)
• These benign nodules are flesh-colored and may be present anywhere on the body, but many are observed on the upper and lower limbs and chest and back region
• Unlike other types of localized lichen myxedematosus, where numerous papules are observed; in this subtype, nodules are formed
• Systemic signs and symptoms are not generally observed

How is Nodular Lichen Myxedematosus Diagnosed?

Nodular Lichen Myxedematosus may be diagnosed through the following tools:

• Complete physical examination with evaluation of medical history
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A skin biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Nodular Lichen Myxedematosus?

The complications of Nodular Lichen Myxedematosus may include:

• Scratching or itching of the lesions may lead to bleeding and ulceration. This can cause secondary bacterial or fungal infections to develop
• Emotional stress due to cosmetic concerns

How is Nodular Lichen Myxedematosus Treated?

Nodular Lichen Myxedematosus is difficult to treat. However, the following treatment options may be considered:

• The healthcare provider may recommend a ‘wait and watch’ approach in some cases
• Use of topical steroids and oral retinoid
• Psoralen and ultraviolet A (PUVA) therapy
• Dermabrasion
• CO2 laser therapy
• Intralesional steroid injections and intralesional hyaluronidase injections
• Newer treatment methods, such as topical tacrolimus creams, have been shown to be successful, in some cases
• Symptomatic and supportive therapy, if needed

How can Nodular Lichen Myxedematosus be Prevented?

Current medical research has not established a method of preventing the occurrence of Nodular Lichen Myxedematosus.

What is the Prognosis of Nodular Lichen Myxedematosus? (Outcomes/Resolutions)

The prognosis of Nodular Lichen Myxedematosus is generally good with adequate treatment, although the condition does not respond well to treatment.

Additional and Relevant Useful Information for Nodular Lichen Myxedematosus:

• Do not pick or scratch the skin lesions
• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition