Xanthome

Yellow nodules

Skin changes that result from storage in serum lipoproteins in macrophages. These can occur both in hyperlipidaemia (as the first clinical sign) and in normolipidaemia.

Xanthelasma are flat xanthomas of the eyelids, although strictly speaking they are an entity in their own right.

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

• Yellow/reddish/tan, rather sharply defined macules, papules or nodules
  • Eruptive xanthomas
    • Clinical
      • Achieve relatively quickly (days - weeks)
      • Can occur disseminated
    • Localisation
      • Gluteal, limb extensor sides
    • Associations
      • Elevation of triglyceride-rich lipoproteins (chylomicrons, VLDL)
      • Diabetes mellitus
  • Tuberous xanthomas
    • Clinic
      • Extensive yellowish, often symmetrical plaques or nodules
    • Localisation
      • Knees, hands, feet and Achilles tendons
    • Association
      • Familial dysbetalipoproteinaemia,
      • Heterozygous familial hypercholesterolaemia
      • Familial apolipoprotein B-100 defect
  • Tendon xanthomas
    • Localisation
      • In particular on extensor tendons (fingers), elbows, patellar tendons and Achilles tendon
    • Association
      • Familial hypercholesterolaemia
      • Familial apolipoprotein B-100 defect
      • Phytosterolaemia
    • Differential diagnosis
      • Gouty tophi
      • Rheumatic nodules
    • Therapy
      • Lowering LDL cholesterol
  • Plane xanthomas
    • Clinic
      • Plane, yellowish skin lesions
    • Association
      • For example, in homozygous familial hypercholesterolaemia
  • Xanthoma verruciforme
    • Clinic
      • Wart-like cutaneous and mucous changes.
    • Differential diagnosis
    • Verruca vulgaris
    • Filiform wart
      • Differentiation is only possible on the basis of histopathology

Xanthelasma

• Xanthelasma palpebrarum:
  Etiopathogenesis
  • 50% of all patients with xanthelasma suffer from dysfunction of lipoprotein metabolism.
• Localisation
  • Medial upper and lower eyelids
• Clinic
  • see above
  • Special forms:
    • Xanthelasma cysticum
      • Comedo-like hyperkeratoses as well as milia-like cysts found in a xanthelasma are called xanthelasma cysticum
      • Hyperpigmentation of the eyelids
      • Differential diagnosis
        • Hidradenomas (syringomas)
        • Milia
        • Solar elastosis with cysts and comedones
      • Prediction
        • Slow progression, despite therapy
  • In early onset, xanthelasmata act as an indicator of atherogenic dyslipoproteinaemia
  • Hutchinson's syndrome
    • Indicates hepatic metabolic disorders

• Anamnesis
• Clinic
• Biopsy if necessary
• Blood lipid values (fasting)

Can occur almost anywhere, especially trunk, extensor sides, glutal region, over tendons, interdigitally.

• Foam cells (lipid-storing macrophages), sometimes Touton's giant cells (when numerous, characteristic of JXG).
• Fibrosis and cholesterol granulomas in the course.

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