Xanthoma
Last Updated: 2020-11-23
ICD11: -
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.
Eruptive xanthomas
Forming relatively fast (days to weeks)
Can occur disseminated
Gluteal, the extension sides of the extremities
↑ Triglyceride-rich lipoproteins (chylomicrons, VLDL)
Tuberous xanthomas
Yellowish, often symmetrical plaques or nodules extending over a large area
Knees, hands, feet and Achilles tendons
Heterozygous familial hypercholesterolemia
Familial apolipoprotein B-100 defect.
Tendon xanthomas
Especially on extensor tendons (fingers), elbows, patellar tendons and Achilles tendon.
Familial hypercholesterolemia
Familial apolipoprotein B-100 defect
Differential diagnosis
Therapy
Lowering LDL cholesterol
Plan xanthomas
Large, yellowish skin lesions.
For example, in homozygous familial hypercholesterolemia
Wart-like cutaneous and mucous changes.
Differential diagnosis
A distinction is only possible on the basis of histopathology.
Xanthelasmata
50% of all patients with xanthelasma suffer from dysfunction of lipoprotein metabolism.
Upper and lower medial eyelids
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
Hidradenoma (syringoma)
Solar elastosis with cysts and comedones
Slow progression despite therapy
In the case of premature occurrence, xanthelasmas act as an indicator of atherogenic Dyslipoproteinemia
Indicates liver metabolism disorders.
Can occur almost everywhere, especially trunk, extensor sides, glutal region, over tendons, interdigital.
In the course fibrosis and cholesterol granulomas.
Therapy of 1st choice by Lebwohl | Evidence level |
Low-fat diet and lipid-lowering therapy |
B |
Therapy of the 2nd choice by Lebwohl | |
Surgical excision | B |
CO2 Laser | B |
Erbium: YAG laser | C |
Pulsed dye laser | B |
Argon laser | B |
Q-switched Nd: YAG laser | D |
KTP laser | D |
1450 nm diode laser | D |
Low-voltage radiofrequency | C |
Therapy of the 3rd choice by Lebwohl |
|
Di-or-trichloracetic acid | C |
Cryotherapy | E |
Bleomycin | B |
Triamcinolone (intralesional) |
D |
Chlorambucil | E |
Prednisolone | E |
Intravenous immunoglobulins | E |
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