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Types Xanthoma

Tuberous xanthomas

Xanthomas are tumor-like collections of foamy histiocytes within the dermis. They may be associated with familial or acquired disorders resulting in hyperlipidemia, with lyphoproliferative malignant neoplasms, or with no underlying disorder.[1] Tuberous xanthomas occur as yellow nodules and are frequently associated with hypertriglyceridemia, but they are also seen in patients with hypercholesterolemia (type II).[2]

We present a case of multiple tuberous xanthomas in a subject with normal lipid metabolism and with no associated systemic disorders, which is an uncommon occurrence. This case is being reported because of its rare occurrence. The aim of this report is to emphasize the importance of considering this disease entity in a patient with normal lipid profile.

  • Firm, uncomplicated, red-yellow nodules that develop about the pressure areas including the knees, elbows, and buttocks. These are a little different than the typical xanthelasma definition but follow the same pattern.
  • Lesions can accumulate together to create multilobulated masses
  • Usually associated with hypercholesterolemia (increased cholesterol levels in blood vessels) and increased LDL levels.
  • These xanthomas are firm swellings that lie deep in the subcutaneous layer of the skin.

Xanthelasma palpebrum

  • Lesions occur symmetrically on higher and lower eyelids
  • Lesions are delicate, yellow papules or plaques
  • Lesions start as small bump and slowly but surely grow greater over almost a year.  as demonstrated in the image, left to thier own devices, xanthelasma on the cheek and xanthelasma on the nose, can be a possible outcome.
  • May or may not be associated with hyperlipidemia

Tendinous xanthomas

Xanthomas are commonly caused by a disturbance of lipoprotein metabolism.[1] Tendon xanthomas are cholesterol deposits in tendons. They appear as slowly enlarging papules or subcutaneous nodules attached to tendons, ligaments, fascia and periosteum and commonly affect the tendons of the dorsal surface of the hands and the achilles tendon. Their presence is a clinical sign of familial hypercholesterolemia, an autosomal dominant inherited disorder characterized by high LDL cholesterol levels and premature cardiovascular disease.

  • Appear as gradually enlarging subcutaneous nodules related to the tendons or ligaments
  • The yellow plaques as stated in the xanthelasma definition occur most commonly in the hands, feet, and Calf muscles.
  • Connected with severe hypercholesterolemia and enhanced LDL levels.
  • They are primarily attached to tendons and are commonly found at the Achilles tendon at the ankle and the extension tendons of the fingers.

Diffuse plane xanthomatosis

Diffuse normolipemic plane xanthoma (DNPX) was first described by Altman and Winkelmann in 1962. It is an uncommon subtype of non-Langerhans histiocytosis [15]. DNPX is characterized by xanthelasma palpebrarum diffuse plane xanthoma of the head, neck, trunk, and extremities; and normal plasma lipid levels. Xanthelasma typically appears first, followed by involvement of the lateral parts of the neck and upper trunk.

  • An exceptional form of histiocytosis that is different from the typical xanthelasma definition.
  • Caused due to an unusual antibody in the bloodstream called a paraprotein.
  • Lipid levels are normal.
  • About 50% will have a malignancy of the blood vessels; usually multiple myeloma or leukemia.
  • Presents with large level reddish-yellow plaques over the facial skin, neck, breasts, and buttocks and in skin folds (like the armpits and groin).

Eruptive xanthomas

Eruptive xanthomatosis (EX) causes small harmless bumps, also known as eruptive xanthomas, on the skin. These bumps are sometimes referred to as lesions, papules, plaques, or a rash.

This rare skin condition happens when you have too much fat or cholesterol in your blood. The bumps are filled with fat. About 10 percent of people with high fat levels in their blood will get EX.

High cholesterol may be caused by some health conditions. In turn, high cholesterol can trigger several serious diseases. Treating EX means getting rid of the excess fat in your body and treating the cause.

  • Lesions typically erupt in groups of small, red-yellow papules
  • Most commonly come up on the buttocks, shoulders, legs, and arms but might occur all around the body
  • Rarely the facial skin and the mouth area may be affected
  • Lesions may be sensitive and usually itchy
  • Strong link with hypertriglyceridemia (increased triglyceride levels in bloodstream) often in patients with diabetes mellitus.

Plane xanthomas

Lesions are flat papules or patches that can occur anywhere on the body
Lesions on the creases of the palms are indicative of a specific pattern of increased lipids in the blood called type III dysbetalipoproteinemia
May be associated with hyperlipidemia and hypertriglyceridemia.

  • Lesions are flat papules or areas that may appear anywhere on your body
  • Lesions on the creases of the hands are indicative of consistent levels of increased lipids in blood vessels called type III dysbetalipoproteinemia
  • Could be associated with hyperlipidemia and hypertriglyceridemia.
  • Combined with tuberous xanthomas is indicative of type 3 dysbetalipoproteinemia.

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