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A patient presented with non-pitting lymphoedema of the legs and finger clubbing. A skin biopsy showed epidermal hyperkeratosis and abundant mucinous material (Alcian blue positive) in reticular dermis. Treatment (radioactive iodine) for Grave's disease (with exophthalmus) 20 years ago, raised suspicion of thyroid dermopathy. Together, these three extrathyroidal manifestations of Graves' disease are typical of the EMO syndrome. In addition, the patient had elevated serum concentrations of thyroid-stimulating hormone receptor autoantibodies. Autoimmune mechanisms are involved in the stimulation of fibroblasts and the production of large amounts of mucin. Pretibial myxoedema relates to scars, mechanical factors, and dependent position. Lack of steroid treatment during radioactive iodine therapy and smoking, may have exacerbated the thyroid dermopathy in this case. Awareness of pretibial myxoedema as a late autoimmune manifestation of Graves' disease, may contribute to earlier diagnosis and correct treatment.

Background: For many years, Norwegian patients with psoriasis or arthritic psoriasis have been offered climate therapy. In 2002, Rikshospitalet University Hospital's department for treatment abroad organised this treatment for the first time for a group of patients with combined psoriasis and arthritic psoriasis., Material and Methods: In 50 patients, psoriasis severity (psoriasis area and severity index, PASI 0-72) was assessed at start and end of treatment in Turkey. Patients reported joint pain (VAS 0-100), skin (DLQI-N 0-29), arthritic psoriasis-related quality of life (ADI-N 0-33) and functional status of arthritis (MHAQ 1-4) at arrival, one week and two months after treatment. Standard response mean (difference/SD difference) was used to evaluate clinical relevance., Results: Disease activity was mild at start of treatment. The clinical relevance for the change in skin and arthritis related quality of life was considered high one week after treatment and moderate after two months. Change in psoriasis, pain and functional status of the joints had little clinic relevance. A statistical significant score improvement was found for PASI (6.0 vs. 2.0), DLQI-N (8.4 vs. 2.2 vs. 4.6), ADI-N (9.9 vs. 4.8 vs. 7.0) and MHAQ (1.6 vs. 1.3 vs. 1.4), all means. No significant change in pain score was demonstrated for those having arthritic psoriasis., Interpretation: If climate therapy should be implemented as supplemental therapy, we recommend recruitment of patients with severe to moderate psoriasis and arthritic psoriasis and inclusion of an analysis of cost-effectiveness.