Skin & Soft Tissue: Xanthoma

Basics

• Localized Lipid Deposits in Tissue
• Lipids Undergo Phagocytosis by Tissue Macrophages (“Foam Cells”)
• Often Associated with Hyperlipidemia or Hypercholesterolemia

Types/Presentation

• Plane (Planar) – Soft Yellow Plaques
  • Xanthelasma – Plane Xanthoma Over Eyelids
    • Most Common Form of Xanthoma Overall
• Eruptive – Acute Inflammatory Red-Yellow Papules
  • Appear Rapidly in Groups of Small (2-5 mm) Lesions
  • Resolve Over 2-3 Weeks
• Tuberous – Firm, Painless, Red-Yellow Nodules
  • Develop Over Areas Under Pressure (Knees, Elbows or Heels)
  • May Coalesce to Form Large Multilobulated Masses
• Tendinous – Slowly Enlarging Subcutaneous Nodules Over Tendons with Normal Overlying Skin
  • Most Common Over the Achilles Tendon & Knuckles

Diagnosis

• Clinical (Based on History of Dyslipidemia and Physical Exam)
• May Require Skin Biopsy

Treatment

• Treat Underlying Pathology
• May Require Surgical Excision if Symptomatic
• Other Options:
  • Topical Trichloroacetic Acid (Chemical Peel)
  • Electrodessication
  • Cryotherapy