6.2.5 Xanthomas

Grading & Level of Importance: C


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.

Aetiology & Pathogenesis

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.

Signs & Symptoms

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.

Laboratory & other workups

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.

Differential diagnosis

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

Prevention & Therapy

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.

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