77
Xanthomas
Key Points
• Four major types of xanthomas: eruptive, tuberous, tendinous, and plane.
• The type of xanthoma and its anatomic location are clues to the specific lipid abnormality or associated disorder (Table 77.1; Figs. 77.1 and 77.2).
Table 77.1
Major types of hyperlipidemia.
apo, apolipoprotein; HDL, high-density lipoprotein; LDL, low-density lipoprotein; LPL, lipoprotein lipase; VLDL, very-low-density lipoprotein.
* Plane xanthomas in the interdigital web space are said to be pathognomonic for the homozygous state.
• DDx depends on the type of xanthoma (Table 77.2).
• In general, Rx is focused on correcting any underlying hyperlipidemia.
Xanthomas Associated with Hyperlipidemia
Eruptive Xanthomas
• Yellow-pink papules, 1–5 mm in diameter.
• May be widespread, but favor the extensor surfaces of the extremities and buttocks (Figs. 77.3 and 77.4).
Fig. 77.3 Eruptive xanthomas due to hypertriglyceridemia. The lesions favored the extensor surface of the lower extremities, in particular the knees.
• An inflammatory halo, tenderness, and/or pruritus may be present.
• Associated with hypertriglyceridemia (often >3000–4000 mg/dl) (see Fig. 77.2).
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