What question did this study set out to answer?

To highlight unusual cutaneous signs related to Graves disease, particularly around the ankles and feet.

April 18, 2026Open Access

Cobblestoned ankles in Graves disease: koebnerized elephantiasic pretibial myxoedema

Key Points

To highlight unusual cutaneous signs related to Graves disease, particularly around the ankles and feet.
Biopsy performed to confirm diagnosis.
Clinical examination to identify skin manifestations.
Histopathological analysis using Alcian blue–PAS stain.
Confirmed presence of compact orthokeratosis and acanthosis in biopsy samples.
Observed abundant interstitial dermal mucin, indicating thyroid dermopathy.
Noted the occurrence of linear koebnerized changes associated with trauma or friction.

Abstract

A 61-year-old man with Graves disease presented with bilateral perimalleolar cobblestoned plaques, elephantiasic pretibial myxoedema, with a linear koebnerized tract. Biopsy confirmed thyroid dermopathy (compact orthokeratosis, acanthosis, abundant interstitial dermal mucin on Alcian blue–PAS). This vignette spotlights the dermatology–internal medicine interface: a distinctive cutaneous sign of thyroid autoimmunity with atypical ankle/foot involvement and trauma/friction as a cofactor.

Cobblestoned ankles in Graves disease: koebnerized elephantiasic pretibial myxoedema

Key Points

Abstract

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