<\/span><\/h2>\nA xanthoma is a skin injury<\/span> caused by the accumulation of fat in macrophage<\/span> immune cells<\/span> on the skin and more rarely in the layer of fat under the skin.<\/p>\nSome types of xanthoma are indicative of lipid<\/span> metabolism<\/span> disorders (for example, hyperlipidemia or high blood fats), where they may be associated with an increased risk of coronary heart disease and occasionally with pancreatitis<\/span>.<\/p>\nXanthomas are classified into the following types based on where they are in the body and how they develop.<\/p>\n
<\/span>Xantelasma palpebrum<\/span><\/h3>\n\n- The most common type of xanthoma<\/li>\n
- Lesions arise symmetrically on the upper and lower eyelids.\n<\/li>\n
- The lesions are smooth, velvety, yellow, flat. papules<\/span> or plates<\/span>\n<\/li>\n
- The lesions start as a small bump and gradually enlarge over several months.<\/li>\n
- May or may not be associated with hyperlipidemia<\/li>\n<\/ul>\n
See more images of xanthelasma.<\/p>\n\n<\/span>Xanthelasma<\/span><\/h5>\n<\/section>\n\n\n
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<\/span>Tuberous xanthoma<\/span><\/h3>\n\n- Firm, painless, red-yellow. nodules<\/span> that develop around pressure areas, such as the knees, elbows, heels, and buttocks<\/li>\n
- Lesions can join to form multilobed masses<\/li>\n
- Usually associated with hypercholesterolemia (increased cholesterol<\/span> blood levels) and increased LDL levels<\/li>\n<\/ul>\n\n
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<\/span>Tendon xanthoma<\/span><\/h3>\n\n- Appears as slow magnification subcutaneous<\/span> nodules related to a tendon or ligament<\/li>\n
- Most commonly found on the hands, feet, and Achilles tendon<\/li>\n
- Associated with severe hypercholesterolemia and elevated LDL levels<\/li>\n<\/ul>\n\n
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<\/span>Eruptive xanthoma<\/span><\/h3>\n\n- The lesions usually appear as small red-yellow papule cultures.<\/li>\n
- Most often they arise on the buttocks, shoulders, arms and legs, but can appear throughout the body.<\/li>\n
- Rarely, the face and the inside of the mouth can be affected.<\/li>\n
- Lesions can be tender and usually itchy<\/li>\n
- Lesions can resolve spontaneously in a few weeks.<\/li>\n
- Associated with hypertriglyceridemia (increased triglycerides<\/span> blood levels) often in patients with diabetes mellitus (sugar diabetes)<\/li>\n<\/ul>\n\n
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<\/span>Flat xanthoma<\/span><\/h3>\n\n- Lesions are flat papules or patches that can appear anywhere on the body.<\/li>\n
- Injuries to the folds of the palms are indicative of a specific pattern of increase lipids<\/span> in the blood called dysbetalipoproteinemia type III<\/li>\n
- May be associated with hyperlipidemia and hypertriglyceridemia<\/li>\n<\/ul>\n
<\/span>\nDiffuse<\/span> flat xanthomatosis<\/span><\/h3>\n\n- A rare form of histiocytosis<\/span>.<\/li>\n
- Associated with an abnormal antibody<\/span> in the blood called a paraprotein<\/span>.<\/li>\n
- Lipid levels are normal.<\/li>\n
- Around 50% will have a malignancy<\/span> blood usually multiple myeloma or leukemia<\/span>.<\/li>\n
- It comes with large flat, reddish-yellow patches on the face, neck, chest, buttocks, and skin folds (such as the armpits and groin).<\/li>\n<\/ul>\n\n
<\/span>Xanthomas diffuse plane<\/span><\/h5>\n<\/section>\n\n\n
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<\/span>Disseminated xanthoma<\/span><\/h3>\n\n- Xanthoma-like lesions due to a rare form of histiocytosis.<\/li>\n
- Lipid metabolism is normal.<\/li>\n
- Skin lesions generally consist of hundreds of small yellowish-brown or reddish-brown bumps, which generally spread evenly on both sides of the face and trunk. They can particularly affect the armpits and groin.<\/li>\n
- Small bumps can join together to form sheets of thickened skin.<\/li>\n
- The 30% of affected people have involvement of the lining of the mouth, airways or eyes (mucous membrane<\/span> surfaces). Warty<\/span> Plaques in the mouth are called verruciform xanthomas.<\/li>\n
- The 40% of affected people develop diabetes insipidus, a condition that results in the inability to control<\/span> water loss (resulting in continuous thirst and excessive urine production). This is due to histiocyte<\/span> overgrowth in the lining of the brain (meninges).<\/li>\n
- It can affect internal organs (such as liver, lungs, kidneys, etc.)<\/li>\n
- Self-limiting and eventually improves on its own, but can persist for many years.<\/li>\n<\/ul>\n\n
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<\/span>What causes xanthoma?<\/span><\/h2>\nThere are several underlying disorders in which xanthoma is caused by an alteration in the metabolism of lipids (fats). Because lipids are insoluble in water, they combine with proteins to form compounds called lipoproteins. Lipoproteins transport lipids and cholesterol in the blood to different parts of the body. Depending on their size and weight, common lipoproteins are classified into chylomicrons, very low-density lipoproteins (VLDL), low-density lipoproteins (LDL), and high-density lipoproteins (HDL) (Fredrickson classification). Everyone has a role to play in maintaining the body's metabolic function.<\/p>\n
Alterations in lipoproteins may be the result of a genetic<\/span> defect (eg. primary<\/span> hyperlipoproteinemia) or some underlying systemic<\/span> disorder like diabetes mellitus, hypothyroidism<\/span>or nephrotic syndrome<\/span>. These underlying diseases can cause elevated levels of certain lipids and lipoproteins, which then manifest as cutaneous<\/span> xanthoma<\/p>\n<\/span>\nMonogenic<\/span> family<\/span> hypercholesterolemia: type IIa<\/span><\/h3>\n\n- \nMutation<\/span> in the LDL receiver<\/span>\n<\/li>\n
- High LDL levels<\/li>\n
- Total cholesterol in heterozygotes 9\u201314 mmol \/ L<\/li>\n
- Total cholesterol in homozygotes 15-30 mmol \/ L<\/li>\n<\/ul>\n
<\/span>Familial polygenic hypercholesterolemia: type IIa<\/span><\/h3>\n\n- Mixed genetic and lifestyle causes<\/li>\n
- Wide range of results<\/li>\n<\/ul>\n
<\/span>Polygenic Familial Combined Hyperlipidemia: Type IIb<\/span><\/h3>\n\n- Mixed genetic and lifestyle causes<\/li>\n
- High total cholesterol<\/li>\n
- High triglycerides<\/li>\n
- Low HDL cholesterol<\/li>\n
- Increased VLDL cholesterol<\/li>\n
- LDL may be normal but denser and more likely to cause atheroma<\/li>\n<\/ul>\n
<\/span>Moderate hypertriglyceridaemia<\/span><\/h3>\n