Xanthelasma: Difference between revisions

	Xanthelasma;
ICD-10	H02.6
ICD-9	374.51
DiseasesDB	28519
MedlinePlus	001447

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Revision as of 13:57, 16 September 2011

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Keywords and Synonyms: plural is xanthelasmata

Overview

Xanthelasma (or xanthelasma palpebrarum) is a sharply demarcated yellowish collection of cholesterol underneath the skin, usually on or around the eyelids. The plural is "xanthelasmata". The root of the word is from Greek xanthos, ξανθος, "yellow".

Xanthelasma are distinct from xanthoma which are larger and nodular, lesions.^[1] Xanthelasma are sometimes classified as a subtype of xanthoma.^[2]

Epidemiology and Demographics

A study of 12,745 people from Denmark identified xanthelasmata in 4.4% of participants aged 20-93.

Natural History, Complications, Prognosis

The lesions themselves are not harmful or painful. They may, however, be a marker of underlying atherosclerosis^[3].

Association with Atherosclerosis

In a prospective population based cohort study (The Copenhagen City Heart Study), a total of 12,745 participants who were free of ischemic heart disease and aged 20-93 years were followed for a mean of 22 years ^[4]. The mulivariate adjusted risk (hazard/odds ratios adjusted for confounders including cholesterol and triglyceride concentrations) of an adverse outcome associated with the presence of xanthelasmata were as follows:

Myocardial infarction: 1.48 (95% confidence interval 1.23 to 1.79)
Ischemic stroke: 0.94 (0.73 to 1.21)
Death: 1.14 (1.04 to 1.26) for death.

Thus, independent of other cardiac risk factors, the presence of a xanthelasma appers to be an independent risk factor for atherosclerotic heart disease. In the same study, arcus senilis was not identified as an independent risk factor^[5].

Differential Diagnosis of Associated Conditions

Diabetes
High cholesterol levels (specifically familial hypercholesterolemia)
LDL receptor deficiency
Menopause
Primary biliary cirrhosis
Vitamin E deficiency (familial isolated, autosomal recessive inheritance)

Treatment

These minor growths may be disfiguring and can be removed. Xanthelasmata can be removed with trichloroacetic acid peel, surgery, lasers or cryotherapy. Removal can cause scarring and pigment changes, but it is unusual after treatment with trichloroacetic acid.

Template:Skin and subcutaneous tissue symptoms and signs Template:Nervous and musculoskeletal system symptoms and signs Template:Urinary system symptoms and signs Template:Cognition, perception, emotional state and behaviour symptoms and signs Template:Speech and voice symptoms and signs Template:General symptoms and signs

da:Xantelasma de:Xanthelasma nl:Xanthelasma sv:Xantelasma

Template:WH Template:WikiDoc Sources

↑ 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
↑ BMJ 2011; 343:d5497
↑ BMJ 2011; 343:d5497
↑ BMJ 2011; 343:d5497

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

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

[3] BMJ 2011; 343:d5497

[4] BMJ 2011; 343:d5497

[5] BMJ 2011; 343:d5497

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[2]

[3]

[4]

[5]

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 ==Natural History, Complications, Prognosis==
-The lesions themselves are not harmful or painful.  They may, however, be a marker of underlying atherosclerosis.
+The lesions themselves are not harmful or painful.  They may, however, be a marker of underlying [[atherosclerosis]]<ref>BMJ 2011; 343:d5497</ref>.
+===Association with Atherosclerosis===
+In a prospective population based cohort study (The Copenhagen City Heart Study), a total of 12,745 participants who were free of ischemic heart disease and aged 20-93 years were followed for a mean of 22 years <ref>BMJ 2011; 343:d5497</ref>.  The mulivariate adjusted risk (hazard/odds ratios adjusted for confounders including [[cholesterol]] and [[triglyceride]] concentrations) of an adverse outcome associated with the presence of xanthelasmata were as follows:
-Prospective population based cohort study.
+*[[Myocardial infarction]]: 1.48 (95% confidence interval 1.23 to 1.79)
+*[[Ischemic stroke]]: 0.94 (0.73 to 1.21)
+* Death: 1.14 (1.04 to 1.26) for death.
-Setting The Copenhagen City Heart Study.
+Thus, independent of other [[cardiac risk factors]], the presence of a xanthelasma appers to be an independent risk factor for [[atherosclerotic heart disease]]. In the same study, [[arcus senilis]] was not identified as an independent risk factor<ref>BMJ 2011; 343:d5497</ref>.
-Participants 12  745 people aged 20-93 years free of ischaemic vascular disease at baseline and followed from 1976-8 until May 2009 with 100% complete follow-up.
-Main outcome measures Hazard ratios for myocardial infarction, ischaemic heart disease, ischaemic stroke, ischaemic cerebrovascular disease, and death; odds ratios for severe atherosclerosis.
-Results 563 (4.4%) of participants had xanthelasmata and 3159 (24.8%) had arcus corneae at baseline. During 33 years’ follow-up (mean 22 years), 1872 developed myocardial infarction, 3699 developed ischaemic heart disease, 1498 developed ischaemic stroke, 1815 developed ischaemic cerebrovascular disease, and 8507 died. Multifactorially adjusted hazard/odds ratios for people with versus those without xanthelasmata were 1.48 (95% confidence interval 1.23 to 1.79) for myocardial infarction, 1.39 (1.20 to 1.60) for ischaemic heart disease, 0.94 (0.73 to 1.21) for ischaemic stroke, 0.91 (0.72 to 1.15) for ischaemic cerebrovascular disease, 1.69 (1.03 to 2.79) for severe atherosclerosis, and 1.14 (1.04 to 1.26) for death. The corresponding hazard/odds ratios for people with versus those without arcus corneae were non-significant. In people with versus those without both xanthelasmata and arcus corneae, hazard/odds ratios were 1.47 (1.09 to 1.99) for myocardial infarction, 1.56 (1.25 to 1.94) for ischaemic heart disease, 0.87 (0.57 to 1.31) for ischaemic stroke, 0.86 (0.58 to 1.26) for ischaemic cerebrovascular disease, 2.75 (0.75 to 10.1) for severe atherosclerosis, and 1.09 (0.93 to 1.28) for death. In all age groups in both women and men, absolute 10 year risk of myocardial infarction, ischaemic heart disease, and death increased in the presence of xanthelasmata. The highest absolute 10 year risks of ischaemic heart disease of 53% and 41% were found in men aged 70-79 years with and without xanthelasmata. Corresponding values in women were 35% and 27%.
-Conclusion Xanthelasmata predict risk of myocardial infarction, ischaemic heart disease, severe atherosclerosis, and death in the general population, independently of well known cardiovascular risk factors, including plasma cholesterol and triglyceride concentrations. In contrast, arcus corneae is not an important independent predictor of risk.
 ==Differential Diagnosis of Associated Conditions==

v t e Symptoms and signs: circulatory (R00–R03, 785)
Cardiovascular	Template:Navbox subgroup
Myeloid/blood	Template:Navbox subgroup

v t e Symptoms and signs: respiratory system (R04–R07, 786)
Hemorrhage	Epistaxis Hemoptysis
Abnormalities of breathing	Respiratory sounds Stridor Wheeze Crackles Rhonchi Hamman's sign Apnea Dyspnea Hyperventilation/Hypoventilation Hyperpnea/Tachypnea/Hypopnea/Bradypnea Orthopnea/Platypnea Trepopnea Biot's respiration Cheyne-Stokes respiration Kussmaul breathing Hiccup Mouth breathing/Snoring Breath-holding
Other	Asphyxia Cough Pleurisy Sputum Respiratory arrest Hypercapnia/Hypocapnia Pectoriloquy: Whispered pectoriloquy Egophony Bronchophony Pleural friction rub Fremitus Silhouette sign
Chest, general	Chest pain Precordial catch syndrome

v t e Symptoms and signs: digestive system and abdomen (R10–R19, 787,789)
GI tract	Template:Navbox subgroup
Accessory	Hepatosplenomegaly/Hepatomegaly Jaundice
Abdominopelvic	Ascites
Abdominal – general	Abdominal pain (Acute abdomen, Colic, Baby colic) Splenomegaly Abdominal guarding · Abdominal mass · Rebound tenderness Shifting dullness · Bulging flanks · Puddle sign · Fluid wave test

v t e Symptoms and signs: Symptoms concerning nutrition, metabolism and development (R62–R64, 783)
Ingestion/Weight	decrease: Anorexia • Weight loss/Cachexia/Underweight increase: Polyphagia • Polydipsia • Orexigenia • Weight gain
Growth	Delayed milestone • Failure to thrive • Short stature (e.g., Idiopathic)