Xanthomas Treatment & Management

Updated: Dec 15, 2017
  • Author: Kara Melissa T Torres, MD, DPDS; Chief Editor: Dirk M Elston, MD  more...
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Treatment

Medical Care

Xanthomas not always associated with underlying hyperlipidemia, but when they are, diagnosing and treating underlying lipid disorders is necessary to decrease the size of the xanthomas and to prevent the risks of atherosclerosis. In patients with severe hypertriglyceridemia, a major goal is to prevent pancreatitis.

Treatment of the hyperlipidemia initially consists of diet and lipid-lowering agents such as statins, fibrates, bile acid–binding resins, probucol, or nicotinic acid. The lipid-lowering effects of these agents have been well documented, but few studies mention the efficacy of these drugs for resolving xanthomas. Eruptive xanthomas usually resolve within weeks of initiating systemic treatment, and tuberous xanthomas usually resolve after months. Tendinous xanthomas take years to resolve or may persist indefinitely.

Pravastatin, probucol, and a regimen of low-fat, low-cholesterol diet and colestipol may help in reducing the size of lesions in tendinous xanthomas and xanthelasmas with hypercholesterolemia. [81, 82, 83, 84, 85] Xanthelasma palpebrarum may respond to systemic interleukin 1 blockade and plane xanthomas to cyclosporine A therapy. [86, 87]

Familial hypercholesterolemia may be treated with combinations of probucol, cholestyramine, clofibrate, and compactin. [83] New hypolipidemic agents for familial hypercholesterolemia include PCSK-9 inhibitors, lomitapide, and mipomersen. [88]

There are no treatment guidelines for xanthoma disseminatum and verruciform xanthomas, but surgical treatment may be appropriate for lesions that are disfiguring or impair function. Xanthoma disseminatum has been described to respond to 2-chlorodeoxyadenosine, simvastatin, or to combination of lipid-lowering agents. [89, 90, 91] Partial resolution in verruciform xanthomas has been described with use of chloroxylenol surgical scrub. [92]

Oral probucol is an alternative treatment to surgical excision for diffuse plane xanthomatosis. [93]

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Surgical Care

The definitive management for all types of xanthomas is surgical.

Xanthelasmas may be treated with topical trichloroacetic acid 50-100%, topical bichloracetic acid, excision, skin flap with blepharoplasty, 1450-nm diode laser, ultrapulsed carbon dioxide laser, argon laser, 1064-nm Q-switched Nd:YAG laser, low-voltage radiofrequency, and fractional carbon dioxide laser. [94, 95, 96, 97, 98, 99, 100, 101, 102, 103, 104, 105] However, lesions may recur. Factors that predict recurrence are systemic hyperlipidemia, involvement of all four eyelids, and previous history of recurrent xanthelasma. [106] Er:YAG laser treatment may be recurrence-free for up to 12 months. [107] Transient erythema, infections, scarring, and postinflammatory hyperpigmentation may occur with all surgical treatment alternatives.

Nonablative 1,450-nm diode laser treatment may achieve satisfactory results for patients with xanthoma disseminatum. [108] Wide excision with skin grafting and carbon dioxide laser ablation may be performed for verruciform xanthomas. [47, 72] Lesions may still recur.

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Complications

Complications from surgical management may occur.

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