Xanthoma

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2]; Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [3]

Synonyms and keywords: Xanthoma, xanthomata, xanthomatosis

Overview

A xanthoma (pl. xanthomas or xanthomata) (condition: xanthomatosis), from Greek xanthos, ξανθος, "yellow", is a deposition of yellowish cholesterol-rich material in tendons or other body parts in various disease states.^[1] They are cutaneous manifestations of lipidosis in which there is an accumulation of lipids in large foam cells within the skin.^[1]

File:Xanthoma histology.jpg

Histology picture of xanthoma showing lipid laden foam cells with large areas of cholesterol clefts, 10 × magnification, eosin and hematoxilin stain. Kumar et al. Cases Journal 2008

They are associated with hyperlipidemias, both primary and secondary types.

Tendon Xanthoma are associated with Type II hyperlipidaemia and chronic biliary obstruction.

Palmar xanthomata and tuboeruptive xanthomata (over knees and elbows) occur in Type III hyperlipidaemia

Causes

Common causes of Xanthomas

Causes by Organ System

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	Hypothyroidism, Myxedema
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	Alagille syndrome, Apolipoprotein C-II deficiency, Apoprotein E deficiency, Cholestanol storage disease, Familial hypercholesterolaemia, Familial hyperlipoproteinemia type 1, Familial hyperlipoproteinemia type 3, Familial hypertriglyceridaemia, Glycogen storage disease type I, Hyperchylomicronemia, Hyperlipoproteinemia, Juvenile xanthogranuloma, Sitosterolemia, Type Ia hyperlipoproteinemia, Type Ib hyperlipoproteinemia, Type Ic hyperlipoproteinemia, Type IIa hyperlipoproteinemia, Type IIb hyperlipoproteinemia, Type III hyperlipoproteinemia, Type IV hyperlipoproteinemia, Type V hyperlipoproteinemia
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	Chronic pancreatitis, Hypercholesterolemia, Hyperlipidaemia, Hypertriglyceridemia, Obesity, Vitamin E deficiency
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	Nephrotic syndrome,
Rheumatology/Immunology/Allergy	Amyloidosis, Primary biliary cirrhosis
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Causes in Alphabetical Order

Types

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.^[2] Still, it is often classified simply as a subtype of xanthoma.^[3]

Xanthoma tuberosum

Xanthoma tuberosum is characterized by xanthomas located over the joints.

Xanthoma tendinosum

Xanthoma tendinosum (also known as "Tendinous xanthoma"^[4]) is clinically characterized by papules and nodules found in the tendons of the hands.

Eruptive xanthoma

Eruptive xanthoma (ILDS E78.220) is clinically characterized by small, yellowish-orange to reddish-brown papules that appear all over the body.

Xanthoma planum

Xanthoma planum (ILDS D76.370), also known as "Plane xanthoma", is clinically characterized by macules and plaques spread diffusely over large areas of the body.

Palmar xanthoma

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

Tuberoeruptive xanthoma (ILDS E78.210) is clinically characterized by red papules and nodules that appear inflamed and tend to coalesce. Tuberous xanthomas are considered similar, and within the same disease spectrum as tuberoeruptive xanthomas.^[4]

Differential Diagnosis of Underlying Causes of Xanthoma

In alphabetical order. ^[5] ^[6]

References

↑ ^1.0 ^1.1 James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.
↑ Shields, Carol; Shields, Jerry (2008). Eyelid, conjunctival, and orbital tumors: atlas and textbook. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7578-7.
↑ thefreedictionary.com > xanthelasma Citing: The American Heritage Medical Dictionary Copyright 2007, 2004 and Mosby's Medical Dictionary, 8th edition. 2009
↑ ^4.0 ^4.1 Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. 1415–16. ISBN 1-4160-2999-0.
↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

[Andrews-1] 1.0 ^1.1 James, William D.; Berger, Timothy G.; et al. (2006). Andrews' Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921-0.

[2] Shields, Carol; Shields, Jerry (2008). Eyelid, conjunctival, and orbital tumors: atlas and textbook. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-7817-7578-7.

[3] thefreedictionary.com > xanthelasma Citing: The American Heritage Medical Dictionary Copyright 2007, 2004 and Mosby's Medical Dictionary, 8th edition. 2009

[Bolognia-4] 4.0 ^4.1 Rapini, Ronald P.; Bolognia, Jean L.; Jorizzo, Joseph L. (2007). Dermatology: 2-Volume Set. St. Louis: Mosby. pp. 1415–16. ISBN 1-4160-2999-0.

[5] Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016

[6] Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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