What Are Xanthelasmas?

Xanthomatosis is a localized aggregation of lipid-containing tissue-foam cells in the dermis, subcutaneous tissues and tendons, forming skin diseases characterized by brown-yellow or orange-yellow patches, pimples or nodules such as skin tumors. Occurs in patients with hyperlipoproteinemia, which is also a common and diagnostic skin manifestation of such patients.

Basic Information

Chinese name: Xanthomatosis
Classification: Primary xanthomatosis and secondary xanthomatosis
Clinical manifestation: Yellow, brownish yellow, orange pimples, nodules

an examination: Physical examination, blood biochemical examination, etc.
Differential diagnosis: Sarcoidosis, etc.
Prognosis: Xanthomatosis has a good prognosis

Etiology of Xanthomas

The cause is unknown. Elevated blood lipids in patients with hyperlipoproteinemia are the main reason. Lipids are deposited in tissues and swallowed by tissue cells to form tissue-foam cells (ie, xanthocarcinoma cells). Such cells aggregate to form xanthomas.

Xanthomatosis classification

Can be divided into primary xanthomatosis and secondary xanthomatosis, the former is divided into two types of familial and non-familial, familial often have varying degrees of dyslipidemia and systemic performance, non-familial often distributed In general, there is no abnormal lipid metabolism and system performance. Secondary xanthomatosis refers to xanthomatosis caused by abnormal blood lipid metabolism caused by other diseases, such as diabetes and lymphoma.

Xanthomatosis clinical manifestations

Skin lesions are yellow, brown, orange, or yellow-red papules, nodules, and plaques. Patients are mostly without symptoms and can be divided into many types.
1. Xanthoma, also known as verrucous verrucous, is the most common type of xanthomatosis, which occurs in middle-aged women. Skin lesions occur in the inner condyle of the upper eyelid. They are symmetrically distributed. They are soft orange-yellow rectangular or polygonal rashes or plaques. They can be present singly or in combination. A few can be fused like a horseshoe. Self-healing. Patients are mostly without symptoms, often associated with other types of xanthomas, and can also appear in patients with various types of familial hyperlipoproteinemia, especially patients with familial hypercholesterolemia.
2. Tendon xanthomas skin damage occurs in the Achilles tendon and the extensor tendons of the hands and feet. It can also occur on the periosteum of the ankle, tibial tuberosity, and elbow, and does not adhere to the skin. The upper skin is normal. The disease is common in patients with familial high cholesterol.
3. Nodular xanthomas skin lesions are more common in the extensor surface of the joint, most of which are elbow and knee joints. Ankle, finger (toe) joints, armpits, groin, face, hips and mucous membranes are also involved. Pimples, pale yellow or orange-yellow nodules, soft, can be flattened or raised with the fibers to form solid round nodules, some of which can be fused into plaques, up to 5cm in diameter. Patients often have no subjective symptoms and can be seen in patients with familial hypercholesterolemia and familial abnormal -lipoproteinemia.
4. Eruptive xanthomas skin lesions occur in the hips, shoulders, hands and arms and knees. The needles or large yellow or orange papules that appear in batches or suddenly occur. The inflammation in the acute phase is obvious. Have redness, may be accompanied by itching or tenderness, may have a homomorphic reaction, after a few weeks can subside on their own, leaving pigmented scars or hypertrophic scars. It is more common in patients with hypertriglyceridemia, mixed hypertriglyceridemia, and elevated concentrations of very low density lipoproteins or chylomicrons in plasma. It can also occur in patients with secondary hyperlipoproteinemia and diabetes.
5. Flat xanthomas skin lesions can occur in any part of the body, as well-defined yellow or orange yellow spots or flat plaques, and are divided into diffuse flat xanthomas, palm (streak) xanthomas, interstitial xanthomas, Cholestatic flat xanthomas and other subtypes.

Xanthomatosis examination

1. Physical examination reveals yellow or orange patches, pimples, or nodular skin lesions characteristic of various types of xanthomatosis.
2. Blood biochemical examination Most patients may have elevated plasma lipoprotein content.
3. Histopathological examination A large number of foamy histological cells infiltrated in the dermis, showing a nodular or diffuse distribution, infiltrated by sparse lymphocytes around the blood vessels, and the epidermis generally thinned.

Xanthomatosis diagnosis

Pay attention to collecting the patient's medical history, may have familial hyperlipoproteinemia; physical examination can be characterized by characteristic yellow or orange patches, pimples or nodular skin lesions, which can be diagnosed; histopathological examination can help confirm the diagnosis.

Xanthomatosis differential diagnosis

1. Sarcoidosis The histopathological examination of this disease is epithelioid-like cell granulomas of varying sizes in the dermis, with few lymphocytes infiltrating around, showing "naked nodules".
2. Langerhans cell histiocytosis Histopathological examination of this disease shows granulomatous changes composed of histiocytes, multinucleated giant cells, eosinophils, lymphocytes and plasma cells. Immunohistochemical staining of histiocytes S-100 Protein positive, CD1a positive.

Xanthomatosis treatment

Choose a low-fat, low-sugar, high-protein diet. Patients with hyperlipidemia can take lipid-lowering drugs orally. Systemic treatment can choose drugs that affect cholesterol and bile salt absorption, drugs that alter lipoprotein synthesis and catabolism, and drugs that affect endogenous cholesterol synthesis. Xanthomas and smaller xanthomas can choose electrocoagulation, liquid nitrogen freezing, carbon dioxide laser, etc., larger xanthomas can be surgically removed.