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Xanthomas

What to know
  • Which types are seen with each familial hyperlipidemia
  • What lab is elevated (tryglycerides vs cholesterol vs both)
  • Increased risk for coronary artery disease
  • What can trigger or exacerbate xanthomas
 
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Tuberous and Tendinous xanthomas are seen in type Two and Three and both start with the letter T. Patients have increased risk for coronary artery disease.
 
 
Eruptive xanthomas
  • present in Type 1, 4 & 5 hyperlipidemia
  • Clinical presentation
    • Small erythematous-yellow papules
    • Extensor surfaces (eg. knees)
    • Koebner phenomenon
    • Hypertriglyceridemia (>3000-4000)
  • Associated with extremely high tryglicerid levels
  • Diabetes, obesity and alcoholism are risk factors → affect liver processing of lipids
  • Can lead to acute pancreatitis
  • Certain drugs can precipitate eruptive xanthomas
    • Isotretinoin
    • Olanzapine
    • Alcohol
    • Estrogen replacement
    • Protease inhibitors
    • These medications stimulate the liver to produce excess tryglicerides
 
Tuberous Xanthomas
  • Type 2&3 hyperlipidemia (Two and Three → Tuberous)
  • Elevated cholesterol and tryglycerides
  • Pink-yellow nodules over elbows and knees
  • Seen in dysbetalipoproteinemia (with plane xanthomas of the palmar crease)
  • Slow to regress
  • Continuum with tuboeruptive xanthomas (which are smaller and usually interdigital)
  • Xanthoma striatum palmare
    • Xanthomas in the palmar creases
    • In 2/3 of patients with type 3 hyperlipidemia
    • Pathognomonic for type 3 hyperlipidemia
 
Tendinous Xanthomas
  • Over achilles and hand tendons
  • Overlying skin is normal
  • Dermal accomulation of lipids
  • Most commonly seen in familial hypercholestrolemia type 2 and 3
 
Plane Xanthomas
  • Large, thin, smooth plaques
  • In adults, should be screened for hyperlipidemia
    • If no hyperlipidemia found, should suspect underlying monoclonal gammopathy of proliferative disorders
  • If intertriginous → homozygous familial hypercholestrolemia
  • If palmar → dysbetalipoproteinemia
 
Xanthelasma
  • Yellowish plaques around the eyelids
  • Only 50% with hyperlipidemia
  • Higher risk of hyperlipidemia in younger patients and with strong family history
  • Screening recommended for dyslipidemia and monoclonal dysglobulinemia
 
Verruciform Xanthoma
  • Oral mucosa, anogenital, periorificial
  • No associated hyperlipidemia
  • Whitish plaques
  • Seen in
    • Lymphedema
    • Epidermolysis bullosa
    • GVHD
    • CHILD syndrome
    • Epidermolysis Bullosa
    • Pemphigus
    • DLE
    • (disorders that are scarring or disturb the epidermis a lot)
 
Tratamento
  • TCA
  • Cirurgia - cortar com tesoura