6.2.5 Xanthomas

5C80.0Z; 5C80.2

Lipid deposition disease.

Xanthomas: a common manifestation of hyperlipidemia. Xanthelasmas: the most common type of xanthomas; in persons older than 50 years; 6% of eyelid tumors.

Tumour-like accumulations of lipid laden macrophages (foam cells) and accumulation of histiocytes.

In xanthomas: systemic or local disturbance in lipid metabolism ( monogenic or polygenic ). In eruptive xanthomas: often triglycerides increased. Disseminated plane xanthomas belong to systemic histiocytoses, also juvenile xanthogranuloma. In xanthelasma often normal lipid metabolism.

Depending on localisation over joints pain may appear. No pruritus.

-Xanthelasmas: soft, flat, yellowish papules.

-Eruptive xanthomas: multiple, small yellow papules. 

-Tuberous xanthomas: firm, yellow nodules. 

-Tendinous xanthomas: subcutaneous nodules. 

-Plane xanthomas:  yellow macules or plaques.

• Xanthelasmas: eyelids. 
• Eruptive xanthomas: buttocks, shoulders, extensor sites of the extremities. 
• Tuberous xanthomas: knees, elbows. 
• Tendinous xanthomas: along the extensor tendons of the hands, the feet, and the Achilles tendons. 
• Plane xanthomas: any site; often in palmar creases.

See Symptoms.

Lipid status incl. subtype specification in xanthomas. 

Vacuolated macrophages (foamy macrophages) in the dermis, occasionally with typical multinucleated histiocytes (Touton giant cells).

The lesions are usually slowly enlarging; eruptive xanthomas may resolve spontaneously.

Patients with hyperlipidemia: atherosclerosis, circulation disorders, cardiac infarction, pancreatitis.

Clinical features and histology.

Syringoma. Nodular and plaque-like localized cutaneous amyloidosis. Lipoid proteinosis.

Prevention: diet and lipid lowering drugs.

Therapy: treatment of individual hyperlipidemia in xanthomas; in disseminated type  subtyping of cell type and bone marrow aspiration. For xanthomas and xanthelasmafor cosmetically disturbing lesions: electrocautery, surgery or Erbium- / CO2 laser.

None.