Xanthomas

Xanthomas are yellowish plaques or nodules due to fat-filled macrophage deposits in the skin. They appear as soft, yellow masses with a well-defined border, located just below the skin surface.

Causes: why do xanthomas form?

The cause of the phenomenon is generally attributable to alterations in lipid metabolism, of a systemic or, more rarely, local nature.

• Xanthomas are common among patients suffering from severe forms of hypercholesterolemia and hypertriglyceridemia, generally on a hereditary (primitive) basis, sometimes appearing to be impressive in homozygous subjects; these patients have very high levels of cholesterol and / or triglycerides in the blood
• Xanthomas may also appear more rarely in patients with primary biliary cirrhosis, pancreatitis, diabetes, heart failure and some forms of cancer and inflammatory diseases.

Classification

There are several forms of xanthomas:

Type of Xanthoma Features Type of disease they are associated with Eyelid xanthomas (xanthomas) Yellowish plaques located around the eyelids, the most common place where xanthomas can be found. They typically occur after the age of 50; they are asymptomatic and generally bilateral and symmetrical Type IIa, IIb and IV hyperlipidemia, not always attributable to lipid alterations Tuberous xanthomas Nodules ranging in size from 5-6 mm to a few centimeters, solid, painless, lobulated, sessile. They develop slowly and mainly affect the areas of pressure, such as the elbows, knees and buttocks Homozygous type IIa hyperlipidemia Tendon, subperiosteal, fascial, aponeurotic xanthomas Subcutaneous nodules attached to tendons, especially that of Achilles, but also to ligaments, muscle bands and periosteum, mainly of the lower limbs Type IIa hyperlipidemia Flat xanthomas They appear as macules or thin palpable yellow-orange plaques, asymptomatic, of variable size. They can be located in the folds of the face and the upper part of the trunk; when they are present in the palms of the hands they become a pathognomic feature of type III dysbetalipoproteinemia Homozygous type IIa and type III hyperlipidemia Eruptive xanthomas They appear as a "sudden eruption of yellow-red papules located on the extensor surfaces of the limbs and on the buttocks. They increase and decrease in size in parallel with plasma changes in triglycerides and lipids. Diabetes and type I, IV and V hyperlipidemia

Symptoms and treatment

Xanthomas tend to be harmless, so much so that they are mostly considered a simple aesthetic disorder; however, since they often represent an expression of high concentrations of lipids in the blood, or are accompanied by other serious pathologies, they are generally associated with a high risk of diseases (especially cardiovascular on an atherosclerotic basis) and other types of disorders.

Treatment of the underlying disease can have a positive effect on many forms of xanthomas. In the specific case of xanthomatosis associated with hyperlipidemia, the pharmacological choices are made between fibrates, statins and nicotinic acid in high doses, possibly supported by supplementation of vitamin E and fatty acids of the omega-three series. In the case of large isolated xanthomas, surgical removal may be considered.

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