Last Updated: 2020-11-23

Author(s): Anzengruber F., Navarini A.

ICD11: -

Skin changes caused by deposition in serum lipoproteins in macrophages. These occur in both hyperlipidemia (as first clinical signs) and normolipidemia.

Xanthelasma are flat xanthomas of the eyelids, although strictly speaking they are a separate entity.

Both a quantitative increase of serum lipids and a disturbed degradation of lipoproteins can be the cause.

  • Yellow / reddish / brownish, rather sharply defined macules, papules or nodules.


Eruptive xanthomas

  • Clinical features
    • Forming relatively fast (days to weeks)

    • Can occur disseminated

  • Localization
    • Gluteal, the extension sides of the extremities

  • Associations
    • ↑ Triglyceride-rich lipoproteins (chylomicrons, VLDL)

    • Diabetes mellitus


Tuberous xanthomas

  • Clinical features
    • Yellowish, often symmetrical plaques or nodules extending over a large area

  • Localization
    • Knees, hands, feet and Achilles tendons

  • Association
    • Familial dysbetalipoproteinemia,
    • Heterozygous familial hypercholesterolemia

    • Familial apolipoprotein B-100 defect.


Tendon xanthomas

  • Localization
    • Especially on extensor tendons (fingers), elbows, patellar tendons and Achilles tendon.

  • Association
    • Familial hypercholesterolemia

    • Familial apolipoprotein B-100 defect

    • Phytosterolemia
  • Differential diagnosis

    • Gouty Tophi
    • Rheumatoid nodules
  • Therapy

    • Lowering LDL cholesterol


Plan xanthomas

  • Clinical features
    • Large, yellowish skin lesions.

  • Association
    • For example, in homozygous familial hypercholesterolemia

  • Xanthoma verruciforme
    • Clinical features
      • Wart-like cutaneous and mucous changes.

    • Differential diagnosis

      • Verruca vulgaris
      • Filiform wart
        • A distinction is only possible on the basis of histopathology.



  • Xanthelasma palpebrarum:
    • 50% of all patients with xanthelasma suffer from dysfunction of lipoprotein metabolism.

  • Localization
    •  Upper and lower medial eyelids

  • Clinical features
    • S.o
    • Special forms::
      • Xanthelasma cysticum
        • In cases of comedo-like hyperkeratoses as well as miliary cysts which are found in a Xanthelasma, one speaks of a Xanthelasma cysticum.

        • Hyperpigmentation of the eyelids

  • Differential diagnosis
    • Hidradenoma (syringoma)

    • Milia
    • Solar elastosis with cysts and comedones

  • Prognosis
    • Slow progression despite therapy

      • In the case of premature occurrence, xanthelasmas act as an indicator of atherogenic Dyslipoproteinemia

      • Hutchinson's syndrome
        • Indicates liver metabolism disorders.

  • Medical history
  • Clinical features
  • Biopsy (if necessary)
  • Blood lipid levels

Can occur almost everywhere, especially trunk, extensor sides, glutal region, over tendons, interdigital.

  • Foam cells (lipid-storing macrophages), sometimes Touton giant cells (if numerous, characteristic of JXG).
  • In the course fibrosis and cholesterol granulomas.

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