Physical findings consistent with Graves thyrotoxicosis, however, are significant, as they are indicative of PTM as the etiology of skin lesions. This is especially true regarding the finding of proptosis because nearly all patients who develop PTM will have thyroid opthalmopathy. Opthalmopathy usually occurs prior to dermopathy. It is characterized clinically by clubbing of fingers and toes, periosteal proliferation of the shafts of phalanges and other distal long bones, and swelling of soft tissues overlying affected bony structures. When present, acropachy usually follows dermopathy.
Early lesions are bilateral, firm, non-pitting, asymmetrical plaques or nodules.
Hair follicles are sometimes prominent, giving a peau d orange texture. Areas of nonpitting edema may also develop. In the elephantiasic form of PTM, lesions may coalesce to give the entire extremity an enlarged, verruciform appearance. Overlying hyperhidrosis or hypertrichosis may also be present in these cases. Skin - Distribution Lesions characteristically appear on the lateral or anterior aspect of the leg, but may occur on the thigh, shoulders, hands, forehead or any other skin surface.