What Is a Xanthoma?

diagnosis

Xanthomas

Xanthoma is a lipid deposition disease with prominent skin damage. Lipid-phagocytic cells are localized in the dermis and tendons, and clinically manifest as yellow, orange, or brown-red papules, nodules, or plaques. It is often accompanied by systemic lipid metabolism disorders and cardiovascular system damage, which can be primary or secondary to other systemic diseases.

diagnosis

It is easy to diagnose based on the characteristics of the lesion, especially the color and distribution of the lesion. What is important is to determine the presence of a concomitant illness. By type of xanthomas. The age of onset, the onset of the family, and the symptoms and examinations of each system, combined with the necessary laboratory test results, can further determine whether it is accompanied by other systemic diseases.

Xanthomas treatment measures

After treatment and control of the accompanying systemic diseases, the xanthomas often fade gradually. For disseminated xanthomas and some eruptive xanthomas, they do not need to be treated because they can resolve on their own.

For some localized lesions, such as meiboma and tendon xanthomas, if it affects beauty or function, local treatment is the main method, such as 33% trichloroacetic acid spot coating, carbon dioxide laser, liquid nitrogen freezing or surgical resection. Larger nodular xanthomas require the patient to undergo surgical resection.

Etiology of Xanthomas

Hyperlipoproteinemia is the main cause of xanthomas. Patients with excessively elevated cholesterol, triglycerides, and phospholipids in plasma lipids tend to deposit locally in the skin and dermis. It is found in various types of primary and secondary hyperlipoproteinemia.

Xanthomas can also occur in people with normal plasma lipids. They are called normal lipoproteinemia xanthomas, and the onset is due to secondary plasma lipid localization due to abnormal changes in plasma proteins or abnormal proliferation of tissue cells. Deposition. As seen in patients with multiple myeloma, hypergammaglobulinemia, macroglobulinemia and lymphoma, leukemia, etc., in some primary histiocytosis and Langerhans histiocytosis (histiocytosis) X) Xanthomas can be seen in other patients. In addition, patients with glucocerebroside disease, sphingomyelinosis, etc. due to genetic enzyme defects can also have xanthomatous lesions.

Xanthopathologic changes

All types of xanthomas have similar tissues. It is mainly the tissue cells (foam cells), also known as xanthomas, that accumulate lipids in the dermis. It is often accompanied by inflammatory cells in the early stage and fibroblasts in the degenerative stage. Multinucleated giant cells (Touton cells) with nucleus arrangement are sometimes seen. Frozen sections stained with scarlet or Sudan red showed the presence of cholesterol and cholesterol esters in foam cells.

Clinical manifestations of xanthomas

According to the morphology and location of xanthomas, there are the following clinical types.

(1) Flat xanthomas are pale yellow to orange-yellow flat papules or plaques slightly higher than the skin surface. The size is from rice grains to broad beans, with clear boundaries. The most common clinically occurring type is around the eyelids, which is called xanthomas, which is common in middle-aged women. It is common in the upper eyelids, single or multiple. It develops slowly, and can spread to the upper and lower eyelids on both sides. A yellow circle around the eyelid is very special. This type of xanthomas often fails to detect lipid abnormalities if they appear after the age of 40, and those with juvenile disease are often accompanied by hyperlipoproteinemia type II. Flat xanthomas occasionally occur symmetrically around the eyelids, neck, trunk and limbs. They are found in middle-aged and elderly people or patients with various abnormal proteinemias. . Flat xanthomas can appear in a linear pattern along the texture of the palm prints and the palms of the fingers, and are called palm print xanthomas, often with hyperlipoproteinemia type III.

(2) Nodular xanthomas are soybean-to-walnut, or even egg-sized pimples or nodules. They are initially soft, yellowish to orange, and later become firm and brown-red due to fibrosis. After slowly increasing and merging, it can show lobular plaques that are significantly higher than the skin surface, with clear boundaries. Occurs in elbows, knees, knuckle extensions, hips, buttocks. Often accompanied by hyperlipoproteinemia type II, III and IV. Nodular xanthomas can occur in tendons, ligaments, and fascia, also known as tendon xanthomas, which are more common in the Achilles tendon, and the nodules are deep and solid. More common in patients with severe hyperlipoproteinemia type and secondary hyperlipoproteinemia.

(3) Eruptive xanthomas are soft small papules with most needles to large matches. They are orange-colored at first, with red halo around, and then turn yellow-brown. Suddenly it comes out of the upper trunk, buttocks and limbs, and it can affect the lips and oral mucosa. Can quickly subside without leaving traces. Patients are often accompanied by hyperlipoproteinemia type , , occasionally type or secondary hyperlipoproteinemia.

(4) Disseminated xanthomas is a rare type of nonfamilial xanthomas with normal lipidemia, which is common in young men. It is a multiple eruptive papule and nodule, which changes from orange to red and yellow to mahogany. Stacked without fusion, often symmetrically distributed in the neck, axilla, elbow fossa, groin, popliteal fossa and trunk flexion. About 1/3 patients have mucosal damage, which can affect the mouth, tongue, nose, throat and even trachea; Patients may involve the posterior pituitary gland and cause diabetes insipidus. The course is chronic but can be resolved spontaneously.

Xanthomas examination

The examination items should include serum appearance, lipid determination and lipoprotein electrophoresis to identify hyperlipoproteinemia and its type. There is a need for protein electrophoresis, serum protein, immunoglobulin determination, cardiovascular system function tests, and xanthopathological examination.