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Dermatology
Xanthomas
Built from Dermatology, 5th Edition
What’s inside
13 sections · 85 slides
Overview
- What this topic covers
Introduction and Epidemiology
What xanthomas are, and how common the underlying lipid problems are
- What is a xanthoma
- Why xanthomas matter clinically
- How common is hyperlipidemia
- How a xanthoma is thought to form
Lipid Metabolism Basics
How fats travel in the blood, and where that system can break
- Lipoproteins: the delivery trucks for fat
- Meet the key apoproteins
- Important apoproteins.
- The exogenous pathway: dietary fat
- Lipoprotein lipase unloads the chylomicron
- Lipoprotein pathways and where disease strikes them
- The endogenous pathway: liver-made fat
- LDL, HDL, and the liver's cholesterol control
- The Frederickson classification
- The five hyperlipoproteinemia types
- Important hyperlipoproteinemias.
- Important hyperlipoproteinemias. (continued)
- With one exception: usually an adult disease
- Working up a patient with a xanthoma
- Laboratory evaluation of suspected hyperlipidemia.
Eruptive Xanthomas
Sudden crops of yellow papules driven by very high triglycerides
- What eruptive xanthomas look like
- Eruptive xanthomas on the legs
- Eruptive xanthomas: colour and clustering
- Eruptive xanthomas with central yellow colour
- Eruptive xanthomas with a "mulberry" pattern
- The trigger: very high triglycerides
- Mechanism 1: failure to clear triglycerides
- Mechanism 2: the liver overproduces triglycerides
- Underlying disorders behind eruptive xanthomas and hypertriglyceridemia
- Isotretinoin and metabolic risk
- Eruptive xanthomas with hypertriglyceridemia and diabetes
- Treating eruptive xanthomas
Tuberous and Tuberoeruptive Xanthomas
Larger, slower-growing lesions tied to high cholesterol
- Tuberoeruptive and tuberous xanthomas
- Tuberoeruptive xanthoma in a child
- Nodular tuberous xanthoma
- Tuberoeruptive xanthomas of the elbow
- Nodular tuberous xanthomas in familial hypercholesterolemia
- Large multilobulated nodular tuberous xanthoma
- Dysbetalipoproteinemia ("broad beta disease")
Tendinous Xanthomas
Firm lumps within tendons - almost always a lipid-disorder clue
- What tendinous xanthomas look like
- Tendinous xanthoma of the Achilles tendon
- Tendinous and web-space plane xanthomas
- Familial hypercholesterolemia: the classic cause
- Familial hypercholesterolemia: severity and xanthoma types
- Two related but different lipid disorders
- Rare causes without a lipoprotein disorder
- Secondary causes of hyperlipidemia
- Secondary hyperlipidemia – selected underlying disorders.
Plane Xanthomas and Xanthelasma
Flat yellow patches, and the sites they favour
- What plane xanthomas look like
- Plane xanthomas of the elbow crease
- Intertriginous plane xanthomas in an infant
- Palmar crease xanthomas
- Xanthelasma: plane xanthomas of the eyelid
- Plane xanthomas from cholestasis
- Normolipemic plane xanthoma
- What drives gammopathy-associated xanthomas
- Normolipemic plane xanthoma with monoclonal IgG gammopathy
Verruciform Xanthomas
A wart-like xanthoma, usually unrelated to blood lipid levels
- Verruciform xanthoma: appearance and sites
- Associated conditions and CHILD syndrome
- How verruciform xanthomas may form
Pathology
What xanthomas look like under the microscope
- The foam cell: the shared hallmark
- Histology of a tuberous xanthoma
- How histology differs by xanthoma type
- Unusual xanthoma-related patterns
- Verruciform xanthoma histology
Differential Diagnosis
Look-alike conditions for each xanthoma type
- What else can look like a xanthoma
- Differential diagnosis of xanthomas.
Treatment
Treating the underlying lipid disorder, plus local options
- The core treatment principle
- Dietary measures
- Lipid-lowering medications
- Lipid-lowering medications.
- Lipid-lowering medications. (continued)
- Lipid-lowering medications. (continued)
- Statins: the first-line class
- Newer options for hard-to-treat disease
- Treating xanthelasma directly
- Treating tendinous xanthomas and CHILD syndrome
Summary
Pulling the xanthoma story together
- Key takeaways
References
Source citations from the chapter
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Dermatology, 5th Edition (2-Volume Set)