Medicine and Surgery: Xanthoma and Xanthelasma

Abel Goa, Saturday, November 17, 2012

Xanthelasma

Xanthelasma (or xanthelasma palpebrum) is a sharply demarcated yellowish deposit of cholesterol underneath the skin, usually on or around the eyelids. Although not harmful or painful, this minor growth may be disfiguring and can be removed. They are common in people of Asian origin and those from Mediterranean origin.

Because of the hereditary component, they may or may not indicate high blood levels of cholesterol. Where there is no family history of xanthelasma, they usually indicate high cholesterol and may correlate with a risk of atheromatous disease.

A xanthelasma may instead be referred to as a xanthoma when becoming larger and nodular, assuming timorous proportions. Still, xanthelasma is often classified simply as a subtype of xanthoma.

ASSOCIATION

Familial hypercholesterolem
Primary biliary cirrhosis
Menopaus
Diabetes

TREATMENT

Xanthelasma can be removed with a trichloroacetic acid peal, surgery, laser vaporization, electrodesiccation or cryotherapy (application of extreme cold to destroy abnormal or diseased tissue). Removal can cause scaring and pigment changes, but it is usually after treatment with trichloroacetic acid.

Xanthoma

Xanthomas are skin lesions caused by the accumulation of fats in macrophage immune cells in the skin and more rarely in the layer of fat under the skin.

Some types of xanthoma are indicative of lipid metabolism disorders (e.g. hyperlipidaemia or high blood fats), where they may be associated with increased risk of coronary artery heart disease and occasionally with pancreatitis.

TYPES

Xanthomas are classified in the following types based on where they are found on the body and how they develop.
Xanthelasma palpebrum – characterized by deposition of cholesterol underneath the skin, usually on or around the eyelids
Xanthoma tendinosum – characterized by papules and nodules found in the tendons of hand, feet, and Achilles
Eruptive xanthoma – characterized by small yellowish-orange to reddish-brown papules that appear all over the body
Palmar xanthoma – characterized by yellowish plaques that involve the palms and the flexural surface of the fingers
Tuberoeruptive xanthoma – characterized by red papules and nodules that appear inflamed and tend to coalesce
Plane xanthomas – lesions are flat papules or patches that can occur anywhere on the body
Diffuse plane xanthomatosis – associated with an abnormal antibody in the blood called a paraprotein. Presents with large flat reddish-yellow plaques over the face, neck, chest, buttocks and in skin folds (such as the armpits and groin)
Xanthoma disseminatum – xanthoma like lesion due to a rare form of hystiocytosis. The skin lesions usually consist of hundreds of yellowish-brown bumps, which are usually spread on both side of the trunk. They may particularly affect the armpit and groin

ASSOCIATION

Certain cancers
Diabetes
Hyperlipidaemia
Familial hypercholesterolaemia
· Primary biliary cirrhosis

TREATMENT

The main aim of treatment for xanthomas that are associated with an underlining lipid disorder is to identify and treat the lipid disorder. In many cases, treating the underlining disorder will reduce or resolve the xanthomas. In addition, treating the hyperlipidaemia will reduce the risk of heart disease, and treating hypertriglyceridaemia will prevent pancreatitis. Dietary and lifestyle modification with or without medication are used to treat lipid disorder.

Dietary measure should include:

Prepare most food from vegetables, salads, cereals and fish
Minimize saturated fats (found in meat, butter, other dairy product, coconut oil, palm oil)
Minimize intake of simple refine sugars found in fizzy drinks, sweets, biscuits and cakes
If obese or overweight, aim to slowly reduce weight by reducing caloric intake and increasing exercise

Effective medication may also be prescribed. This may include: statins (HMG CoA reductase inhibitors, such as simvastatin and atoravastin, reduce cholesterol production by the liver), fibrates (such as bezafibrate, may be added to reduce triglyceride production by the liver), Ezetimibe (reduces cholesterol absorption from gut) may be added in high risk patient or if higher doses of statin are poorly tolerated, nicotinic acid (lowers cholesterol and triglyceride).

Surgery or locally destructive modalities can be used to remove xanthomas that do not resolve spontaneously or with treatment of the underlining cause.