Xanthomas are yellowish plaques or nodules due to deposits of macrophages stuffed with fat in the skin. They appear as soft, yellow masses with a well-defined border, located just below the skin surface.
Causes: why are xanthomas formed?
The cause of the phenomenon is generally due to alterations in the metabolism of lipids, of a systemic or rarely local nature.
- Xanthomas are common among patients with severe forms of hypercholesterolemia and hypertriglyceridemia, generally on a hereditary (primitive) basis, sometimes appearing to be large in homozygous individuals; these patients have very high blood cholesterol and / or triglyceride levels
- Xanthomas may occur more rarely even in patients with primary biliary cirrhosis, pancreatitis, diabetes, heart failure and some forms of cancer and inflammatory diseases
Classification
There are different forms of xanthomas:
| Type of Xanthoma | Features | Type of disease to which they are associated |
| Eyelid Xanthomas (xanthoplasms) | 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 due to lipid alterations |
| Tuberous Xanthomas | Nodules of variable size from 5-6 mm to a few centimeters, solid, painless, lobulated, sessile. They develop slowly and affect mainly pressure areas, such as the elbows, knees and buttocks | Type IIa homozygous hyperlipidemia |
| Tendon, subperiosteal, fascial, aponeurotic Xanthomas | Subcutaneous nodules adhering to tendons, especially that of Achilles, but also to ligaments, muscle bands and periosteum, mainly of the lower limbs | Type IIa hyperlipidemia |
| Xanthomas planes | They appear as macules or thin yellow-orange palpable plaques, asymptomatic, of variable size. They can be located in the folds of the face and upper part of the trunk; when they are present in the palm of the hands they become a pathognomic characteristic of type III disbetalipoproteinemia | Type IIa homozygous 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 the plasma changes of triglycerides and lipids. | Diabetes and hyperlipidemia type I, IV and V |
Symptoms and cure
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 associated with 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 high-dose nicotinic acid, possibly supported by vitamin E and omega-three series fatty acids. In the case of large xanthomas, surgical removal can be evaluated.
Read also: All Remedies for Xanthomas ยป
