A xanthoma , from Greek (xanthos), meaning ‘yellow’, is a deposition of yellowish cholesterol-rich material that can appear anywhere in the body in various disease states. They are cutaneous manifestations of lipidosis in which lipids accumulate in large foam cells within the skin.They are associated with hyperlipidemias, both primary and secondary types.
Tendon xanthomas are associated with type II hyperlipidemia, chronic biliary tract obstruction, and primary biliary cirrhosis. Palmar xanthomata and tuboeruptive xanthomata (over knees and elbows) occur in type III hyperlipidemia.
Familial homozygous hypercholesterolemia is one of the high risk factors that can result in premature coronary arterial disease leading to severe morbidity and premature death in children and young adults. We describe a rare example of extensive xanthoma tuberosum in a case of familial homozygous hypercholesterolemia.
Types of Xanthelasma
A xanthelasma is a sharply demarcated yellowish collection of cholesterol underneath the skin, usually on or around the eyelids. Strictly, a xanthelasma is a distinct condition, only being called a xanthoma when becoming larger and nodular, assuming tumorous proportions. Still, it is often classified simply as a subtype of xanthoma.
Xanthoma tuberosum (also known as tuberous xanthoma) is characterized by xanthomas located over the joints.
Xanthoma tendinosum (also tendon xanthoma or tendinous xanthoma) is clinically characterized by papules and nodules found in the tendons of the hands, feet, and heel. Also associated with familial hypercholesterolemia (FH).
Eruptive xanthoma is clinically characterized by small, yellowish-orange to reddish-brown papules that appear all over the body. It tends to be associated with elevated triglycerides.
Xanthoma planum, also known as plane xanthoma, is clinically characterized by macules and plaques spread diffusely over large areas of the body.
Palmar xanthoma is clinically characterized by yellowish plaques that involve the palms and flexural surfaces of the fingers. Plane xanthomas are characterised by yellowish to orange, flat macules or slightly elevated plaques, often with a central white area which may be localised or generalised. They often arise in the skin folds, especially the palmar creases.
They occur in hyperlipoproteinaemia type III and type IIA, and in association with biliary cirrhosis. The presence of palmar xanthomata, like the presence of tendinous xanthomata, is indicative of hypercholesterolaemia.
Tuberoeruptive xanthoma is clinically characterized by red papules and nodules that appear inflamed and tend to coalesce. Tuberous xanthomata are considered similar, and within the same disease spectrum as eruptive xanthomata.
Other types of xanthoma identified in the Medical Dictionary include:
- eruptive x.: usually appearing on the back and buttocks, or the extensors of knees and elbows of hyperlipemic individuals, it is the sudden appearance of groups of yellowish-brown papules surrounded by an erythematous halo.
- x. diabeticorum: a type of eruptive xanthoma, often with severe diabetes.
- x. disseminatum: a rare xanthoma, consisting of non-X histiocytes on flexural surfaces, associated with diabetes insipidus.
- x. planum: yellow bands or rectangular plates in the corium.
- verrucous x.: aka histocytosis Y, a papilloma of the oral mucosa and skin, whereby the connective tissue under the epithelium contains histiocytes.
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