Laboratory Studies

Primary hyperlipidemia is primarily a diagnosis of exclusion. Appropriate blood, urine, and radiographic workups are required to rule out a secondary cause of hyperlipidemia. Lipoprotein profiles are primarily used to assess cardiac risk and to aid in the diagnosis of lipid metabolism disorders.

Plasma levels of triglyceride, cholesterol, and HDL-cholesterol are measured following a 12-hour fast before venipuncture. Cholesterol and triglyceride levels are usually measured by enzymatic methods. HDL-cholesterol levels can be measured after the apoprotein B–containing lipoproteins (chylomicrons, VLDL, IDL, LDL, Lp[a]) are removed by polyanion-divalent cation precipitation. LDL and VLDL can then be calculated as follows:

LDL = Total Cholesterol Level – (Triglyceride Levels/5 + HDL Level)
VLDL = Triglyceride Levels/5*

*If triglycerides are greater than 700, the denominator is 10.

Chylomicrons, because of their high lipid-protein ratio, are less dense and form a creamy layer when plasma is left standing for several hours. Ultracentrifugation fractions can be electrophoretically examined for the presence of beta-VLDL and Lp(a). Quantification of apolipoproteins, particularly B and A-I, can be achieved by immunologic methods.

Lipoprotein patterns can be determined as follows:

I - Elevated triglyceride levels with increased chylomicron levels
IIa - Elevated cholesterol level because of increased LDL level
IIb - Elevated cholesterol and triglyceride levels because of increased LDL and VLDL levels
III - Elevated cholesterol and triglyceride levels, with the presence of beta-VLDL
IV - Elevated triglyceride levels because of increased VLDL level
V - Elevated triglyceride levels because of increased VLDL level and the presence of chylomicrons

The risk for cardiovascular disease can be determined on the basis of the total cholesterol, LDL-cholesterol, and HDL-cholesterol values in adults and children.

Genetic testing can detect the CYP27A1 gene that confirms cerebrotendinous xanthoma. Plasma cholestanol is a helpful diagnostic marker.

Imaging Studies

Ultrasonography and MRI may enhance the diagnosis of tendon xanthomas and are used for surgical planning.^{[84, 85, 86]}

Positron-emission tomography/computed tomography may be used to detect disease extent and assess treatment response in cases of xanthoma disseminatum.^[87]

Histologic Findings

All types of xanthomas in the skin and the tendons are characterized by the presence of large, vacuolated macrophages (xanthoma cell). These macrophages are filled with lipid droplets, which are dissolved and removed from the tissue during histologic processing. Lipid stains are of no use in routinely processed tissue. In contrast, frozen sections can be stained with lipid stains. Foamy histiocytes usually have one nucleus, but multinucleated histiocytes (Touton giant cells) are often identified. Xanthoma cells are positive with CD68, macrophage scavenger receptor-I, monocyte chemoattractant protein-I, CCR2, and oxidized low-density lipoprotein.^[82]CD1a is typically negative.

See the image below.

Microscopic image of a xanthelasma. The lesion is composed of lipid-laden macrophages located in the superficial dermis. Courtesy of Duke University Medical Center.

View Media Gallery

Eruptive xanthomas may contain infiltrates of lymphocytes and typically contain extracellular lipid. Rarely, eruptive neutrophilic xanthomas with prominent leukocytoclasis may occur.^[88]Xanthelasma shows foam cells in the upper reticular dermis with overlying thin epidermis, characteristic of eyelid skin. Tendinous and tuberous xanthomas may contain prominent fibrosis and occasional cholesterol clefts. Verruciform xanthoma is histologically characterized by hyperkeratosis or parakeratosis with acanthosis, and often with a polymorphonuclear infiltrate. Red wedge-shaped areas of epidermal necrosis are characteristically present.^[89]Epidermolytic acanthoma is rare but may occur.^[90]

Treatment & Management

Mahmood T, Samarasinghe S, John L. A Case Report on Eruptive Xanthoma as the First Presentation of Undiagnosed Diabetes Mellitus. Endocrine Abstracts. 2020. 69:P55. [Full Text].
Sharma D, Thirkannad S. Palmar Xanthoma-An Indicator of a More Sinister Problem. Hand (N Y). 2009 Sep 22. [QxMD MEDLINE Link].
Duzayak S, Sayiner ZA, Erkılıç S, Inaloz HS. Acute pancreatitis with eruptive xanthoma. BMJ Case Rep. 2017 Oct 9. 2017:[QxMD MEDLINE Link].
Rupec RA, Schaller M. Xanthoma disseminatum. Int J Dermatol. 2002 Dec. 41(12):911-3. [QxMD MEDLINE Link].
Behra A, Sa DK, Naik R, Patel RK. A Rare Case of Persistent Xanthoma Disseminatum without Any Systemic Involvement. Indian J Dermatol. 2020 May-Jun. 65 (3):239-241. [QxMD MEDLINE Link].
Natanzi N, Peng D, Ahdoot E, Ghatan S, Reinstandler A, Ram R. Xanthoma disseminatum in a pair of blind, deaf male twins. ISRN Dermatol. 2011. 2011:342909. [QxMD MEDLINE Link]. [Full Text].
Bragg J. Diffuse plane xanthomata. Dermatol Online J. 2005 Dec 30. 11(4):4. [QxMD MEDLINE Link].
Kim JG, Kim HR, You MH, Shin DH, Choi JS, Bae YK. Necrobiotic Xanthogranuloma Coexists with Diffuse Normolipidemic Plane Xanthoma and Multiple Myeloma. Ann Dermatol. 2020 Feb. 32 (1):53-56. [QxMD MEDLINE Link].
Cumberland L, Dana A, Resh B, Fitzpatrick J, Goldenberg G. Verruciform xanthoma in the setting of cutaneous trauma and chronic inflammation: report of a patient and a brief review of the literature. J Cutan Pathol. 2010 Aug. 37(8):895-900. [QxMD MEDLINE Link].
Fite C, Plantier F, Dupin N, Avril MF, Moyal-Barracco M. Vulvar verruciform xanthoma: ten cases associated with lichen sclerosus, lichen planus, or other conditions. Arch Dermatol. 2011 Sep. 147(9):1087-92. [QxMD MEDLINE Link].
Lu S, Rohwedder A, Murphy M, Carlson JA. Verruciform xanthoma: localized lymphedema (elephantiasis) is an essential pathogenic factor. J Cutan Pathol. 2012 Mar. 39(3):391-4. [QxMD MEDLINE Link].
Mori T, Hiraiwa T, Hanami Y, Yamamoto T. Verruciform Xanthoma Occurring after Surgery for Genital Paget's Disease. Indian Dermatol Online J. 2021 Jan-Feb. 12 (1):174-175. [QxMD MEDLINE Link].
Sheetal S, Byju P. Cerebrotendinous xanthomatosis: Clinical and neuroimaging findings. Arch Med Health Sci. 2020. 8:161-2. [Full Text].
Baila-Rueda L, Mateo-Gallego R, Lamiquiz-Moneo I, Cenarro A, Civeira F. Severe hypercholesterolemia and phytosterolemia with extensive xanthomas in primary biliary cirrhosis: Role of biliary excretion on sterol homeostasis. J Clin Lipidol. 2014 Sep-Oct. 8(5):520-4. [QxMD MEDLINE Link].
Taylor B, Cheema A, Soslowsky L. Tendon Pathology in Hypercholesterolemia and Familial Hypercholesterolemia. Curr Rheumatol Rep. 2017 Nov 4. 19 (12):76. [QxMD MEDLINE Link].
Asati P. Study of Patients with Non Alcoholic Fatty Liver Disease and its Association with Metabolic Syndrome in tertiary centre. J Med Sci Clin Res. 2017. 05:22901-22904. [Full Text].
Deprez M, Uffer S. Clinicopathological features of eyelid skin tumors. A retrospective study of 5504 cases and review of literature. Am J Dermatopathol. 2009 May. 31(3):256-62. [QxMD MEDLINE Link].
Altman J, Winkelmann RK. Xanthoma disseminatum. Arch Dermatol. 1962. 86:582-96.
Davies CW, Marren P, Juniper MC, Gray W, Wojnorowska F, Benson MK. Xanthoma disseminatum with respiratory tract involvement and fatal outcome. Thorax. 2000 Feb. 55(2):170-2. [QxMD MEDLINE Link]. [Full Text].
Park HY, Cho DH, Kang HC, Yun SJ. A case of xanthoma disseminatum with spontaneous resolution over 10 years: review of the literature on long-term follow-up. Dermatology. 2011. 222(3):236-43. [QxMD MEDLINE Link].
Kim YR, Han KH. Familial hypercholesterolemia and the atherosclerotic disease. Korean Circ J. 2013 Jun. 43(6):363-7. [QxMD MEDLINE Link]. [Full Text].
Al Montasir A, Sadik MH. Acute myocardial infarction in a 28 year man with familial hypercholesterolemia. Indian J Med Sci. 2012 Mar-Apr. 66(3-4):78-81. [QxMD MEDLINE Link].
Ghosh SK, Majumder B, Dutta A. Tuberous xanthoma as a presenting feature of familial homozygous hypercholesterolemia with aortic regurgitation. J Pediatr. 2015 Jan. 166(1):198. [QxMD MEDLINE Link].
Jetha MM, Fiorillo L. Xanthomata and diabetes in an adolescent with familial dysbetalipoproteinemia 9 yr after valproate-induced pancreatitis. Pediatr Diabetes. 2012 Aug. 13(5):444-7. [QxMD MEDLINE Link].
Singh AP, Sikarwar S, Jatav OP, Saify K. Normolipemic tuberous xanthomas. Indian J Dermatol. 2009. 54(2):176-9. [QxMD MEDLINE Link]. [Full Text].
Sinnott BP, Mazzone T. Tuberous xanthomas associated with olanzapine therapy and hypertriglyceridemia in the setting of a rare apolipoprotein E mutation. Endocr Pract. 2006 Mar-Apr. 12(2):183-7. [QxMD MEDLINE Link].
Brown CA, Lesher JL Jr, Peterson CM. Tuberous and tendinous xanthomata secondary to ritonavir-associated hyperlipidemia. J Am Acad Dermatol. 2005 May. 52(5 Suppl 1):S86-9. [QxMD MEDLINE Link].
Guidry J, Thompson W, Sonabend M. Chronic myelomonocytic leukemia can present with diffuse planar xanthoma. Dermatol Online J. 2014 Jul 15. 20(7):[QxMD MEDLINE Link].
Emberger M, Zelger BW, Laimer M, Burgdorf W. Plaque-like papular xanthoma, an unusual, localized variant of non-Langerhans cell disease. Eur J Dermatol. 2013 Apr 1. 23(2):278-9. [QxMD MEDLINE Link].
Matsumoto M, Ikeda M, Takeya M, Kodama H. Plane xanthoma associated with multiple mastocytoma. Pediatr Dermatol. 2007 Sep-Oct. 24(5):E66-9. [QxMD MEDLINE Link].
Fujimoto N, Mieno H, Hosokawa R, Fujimoto E, Tajima S. Ultraviolet irradiation may generate plane xanthomas on mycosis fungoides. Br J Dermatol. 2013 Jan. 168(1):218-20. [QxMD MEDLINE Link].
Kutlubay Z, Engin B, Uzuncakmak TK, Demirkesen C, Altiti MM, Karter Y, et al. POEMS syndrome (polyneuropathy organomegaly endocrinopathy M-protein skin changes) with xanthoma - a case report. J Eur Acad Dermatol Venereol. 2014 Oct 8. [QxMD MEDLINE Link].
Maejima H, Katsuoka K. Sarcoidosis coexisting with eruptive xanthoma. Eur J Dermatol. 2011 Mar-Apr. 21(2):298-9. [QxMD MEDLINE Link].
Fett N, Teng JM. Xanthoma striatum palmare associated with nonsyndromic paucity of the interlobular bile ducts. Cutis. 2014 May. 93(5):E6-8. [QxMD MEDLINE Link].
Pearson HJ, Mosser JL, Jacks SK. The triad of pruritus, xanthomas, and cholestasis: Two cases and a brief review of the literature. Pediatr Dermatol. 2017 Nov. 34 (6):e305-e308. [QxMD MEDLINE Link].
Giller RH, Folberg R, Keech RV, Piette WW, Sato Y. Xanthoma disseminatum. An unusual histiocytosis syndrome. Am J Pediatr Hematol Oncol. 1988 Fall. 10(3):252-7. [QxMD MEDLINE Link].
Szyfter W, Wierzbicka M, Bem G. [Rare case of xanthoma disseminatum with severe dyspnoea]. Otolaryngol Pol. 2006. 60(1):67-70. [QxMD MEDLINE Link].
Kim JY, Jung HD, Choe YS, Lee WJ, Lee SJ, Kim do W, et al. A Case of Xanthoma Disseminatum Accentuating over the Eyelids. Ann Dermatol. 2010 Aug. 22(3):353-7. [QxMD MEDLINE Link]. [Full Text].
Büyükavci M, Selimoglu A, Yildirim U, Ertekin V, Atasoy M. Xanthoma disseminatum with hepatic involvement in a child. Pediatr Dermatol. 2005 Nov-Dec. 22(6):550-3. [QxMD MEDLINE Link].
Zak IT, Altinok D, Neilsen SS, Kish KK. Xanthoma disseminatum of the central nervous system and cranium. AJNR Am J Neuroradiol. 2006 Apr. 27(4):919-21. [QxMD MEDLINE Link].
Gupta P, Khandpur S, Vedi K, Singh MK, Walia R. Xanthoma disseminatum associated with inflammatory arthritis and synovitis--a rare association. Pediatr Dermatol. 2015 Jan-Feb. 32(1):e1-4. [QxMD MEDLINE Link].
Oka M, Oniki S, Komatsu M, Ikeda T, Matsuo M, Miyamoto Y, et al. Xanthoma disseminatum with intracranial involvement: case report and literature review. Int J Dermatol. 2010 Feb. 49(2):193-9. [QxMD MEDLINE Link].
Zinoun M, Hali F, Marnissi F, Lazaar S, Benchikhi H. [Xanthoma disseminatum with asymptomatic multisystem involvement.]. Ann Dermatol Venereol. 2015 Jan 24. [QxMD MEDLINE Link].
Ghorpade A. Xanthoma disseminatum with koebnerized pearly penile lesions in an Indian man. Int J Dermatol. 2009 Sep. 48(9):996-8. [QxMD MEDLINE Link].
Attia AM, Bakry OA, Mohamed EE. Xanthoma disseminatum: a progressive case with multisystem involvement. J Postgrad Med. 2014 Jan-Mar. 60(1):69-71. [QxMD MEDLINE Link].
Spanou Z, Borradori L. Diffuse plane xanthomas, a cutaneous marker for monoclonal gammopathies and lymphoproliferative diseases. Eur J Haematol. 2011 Jan. 86(1):91. [QxMD MEDLINE Link].
Bürgesser MV, Calafat P, Diller A. [Diffuse plane xanthomatosis associated with haematologic disorder and solid tumor. Findings of an autopsy]. Rev Fac Cien Med Univ Nac Cordoba. 2011. 68(2):65-9. [QxMD MEDLINE Link].
Silva DM, Chacha JJ, Wiziack Nde C, Takita LC, Hayashi FK. [Diffuse plane idiopathic normolipemic xanthoma with hypersplenism]. An Bras Dermatol. 2010 Jan-Feb. 85(1):73-6. [QxMD MEDLINE Link].
García-Arpa M, Rodríguez-Vázquez M, Vera E, Romero G, González-García J, Cortina P. [Normolipemic plane xanthomas and mycosis fungoides]. Actas Dermosifiliogr. 2005 Jun. 96(5):307-10. [QxMD MEDLINE Link].
Koçak M, Keles H, Yakaryilmaz F, Bozdogan O, Güliter S. Diffuse plane xanthomatosis in a patient with Budd-Chiari syndrome and monoclonal gammopathy. Indian J Dermatol. 2009. 54(4):369-71. [QxMD MEDLINE Link]. [Full Text].
Lu YT, Chen TJ, Chung WH, Kuo TT, Hong HS. Cutaneous normolipemic plane xanthoma with supraglottic involvement in a patient with hand-Schüller-Christian Disease: a case report. Am J Clin Dermatol. 2009. 10(3):189-92. [QxMD MEDLINE Link].
Campanati A, Goteri G, Simonetti O, Marconi B, Brandozzi G, Ganzetti G, et al. Normolipemic plane xanthomatosis with acute development preceding the clinical onset of rheumatoid arthritis. J Cutan Pathol. 2009 Oct. 36 Suppl 1:13-5. [QxMD MEDLINE Link].
Seo HM, Jang JW, Park SK, Jung YJ, Kim TL, Kim YG, et al. A Case of Verruciform Xanthoma of the Sole. Ann Dermatol. 2021 Feb. 33 (1):86-88. [QxMD MEDLINE Link].
Ko JY, Shin H, Lee CW. A verruciform xanthoma-like phenomenon in a linear epidermal naevus in the absence of a syndromic association. Br J Dermatol. 2008 Aug. 159(2):493-6. [QxMD MEDLINE Link].
Poulopoulos AK, Epivatianos A, Zaraboukas T, Antoniades D. Verruciform xanthoma coexisting with oral discoid lupus erythematosus. Br J Oral Maxillofac Surg. 2007 Mar. 45(2):159-60. [QxMD MEDLINE Link].
Gehrig RD, Baughman RA, Collins JF. Verruciform xanthoma in a young male patient with a past history of pemphigus vulgaris. Oral Surg Oral Med Oral Pathol. 1983 Jan. 55(1):58-61. [QxMD MEDLINE Link].
Orpin SD, Scott IC, Rajaratnam R, Colloby PS, Heagerty A. A rare case of recessive dystrophic epidermolysis bullosa and verruciform xanthoma. Clin Exp Dermatol. 2009 Jan. 34(1):49-51. [QxMD MEDLINE Link].
Shahrabi Farahani S, Treister NS, Khan Z, Woo SB. Oral verruciform xanthoma associated with chronic graft-versus-host disease: a report of five cases and a review of the literature. Head Neck Pathol. 2011 Jun. 5(2):193-8. [QxMD MEDLINE Link]. [Full Text].
Jensen JL, Liao SY, Jeffes EW 3rd. Verruciform xanthoma of the ear with coexisting epidermal dysplasia. Am J Dermatopathol. 1992 Oct. 14(5):426-30. [QxMD MEDLINE Link].
Mannes KD, Dekle CL, Requena L, Sangueza OP. Verruciform xanthoma associated with squamous cell carcinoma. Am J Dermatopathol. 1999 Feb. 21(1):66-9. [QxMD MEDLINE Link].
Xu XL, Huang LM, Wang Q, Sun JF. Multiple verruciform xanthomas in the setting of congenital hemidysplasia with ichthyosiform erythroderma and limb defects syndrome. Pediatr Dermatol. 2015 Jan-Feb. 32(1):135-7. [QxMD MEDLINE Link].
Yamamoto T, Katayama I, Nishioka K. Verruciform xanthoma in a psoriatic patient under PUVA therapy. Dermatology. 1995. 191(3):254-6. [QxMD MEDLINE Link].
Salamanca J, Alemany I, Sosa G, Pinedo F, Hernando S, Martín-Acosta P. Esophageal verruciform xanthoma following radiotherapy. Gastroenterol Hepatol. 2012 May. 35(5):317-20. [QxMD MEDLINE Link].
Helm KF, Höpfl RM, Kreider JW, Lookingbill DP. Verruciform xanthoma in an immunocompromised patient: a case report and immunohistochemical study. J Cutan Pathol. 1993 Feb. 20(1):84-6. [QxMD MEDLINE Link].
Blankenship DW, Zech L, Mirzabeigi M, Venna S. Verruciform xanthoma of the upper-extremity in the absence of chronic skin disease or syndrome: a case report and review of the literature. J Cutan Pathol. 2013 Aug. 40(8):745-52. [QxMD MEDLINE Link].
Pai VV, Shukla P, Bhobe M. Combined planar and eruptive xanthoma in a patient with type lla hyperlipoproteinemia. Indian J Dermatol Venereol Leprol. 2014 Sep-Oct. 80(5):467-70. [QxMD MEDLINE Link].
Aliasgarzadeh A, Ghorbanian M, Naghavi-Behzad M. Familial dysbetalipoproteinaemia presenting with cauliflower xanthoma. Niger Med J. 2013 Jul. 54(4):268-70. [QxMD MEDLINE Link]. [Full Text].
Kalidas K, Behrouz R. Inherited metabolic disorders and cerebral infarction. Expert Rev Neurother. 2008 Nov. 8(11):1731-41. [QxMD MEDLINE Link].
Corradino B, Di Lorenzo S, Triolo A, Moschella F. Laser treatment of giant xanthelasma palpebrarum. Lasers Med Sci. 2014 Sep 25. [QxMD MEDLINE Link].
Moorthy N, Ananthakrishna R, Bhat P, Nanjappa MC. Xanthoma tuberosum in homozygous familial hypercholesterolemia. Ann Pediatr Cardiol. 2014 May. 7(2):118-9. [QxMD MEDLINE Link]. [Full Text].
Fujiwara S, Oka M, Kunisada M, Honjo K, Nishigori C. Severe xanthomatosis with prominent tuberous xanthomas on the cheeks and the nasal dorsum in a patient with type IIa hyperlipoproteinemia. Eur J Dermatol. 2013 Jul-Aug. 23(4):517-8. [QxMD MEDLINE Link].
Agarwal S, Akhtar MN. Great toe gouty tophus-like lesion revealing extensive tendon xanthomatosis in a asymptomatic hyperuricemic patient. J Postgrad Med. 2013 Jul-Sep. 59(3):238-9. [QxMD MEDLINE Link].
Errichetti E, Piccirillo A, Tataranni M, Ricciuti F, Liao KL, Cheng ZL, et al. A case of diffuse plane normolipemic xanthomatosis presenting with oral lesions. G Ital Dermatol Venereol. 2014 Apr. 149(2):278-80. [QxMD MEDLINE Link].
Caputo R, Monti M, Berti E, Gasparini G. Normolipemic eruptive cutaneous xanthomatosis. Arch Dermatol. 1986 Nov. 122(11):1294-7. [QxMD MEDLINE Link].
Ansarin H, Berenji Ardestani H, Tabaie SM, Shayanfar N. Xanthoma disseminatum with tumor-like lesion on face. Case Rep Dermatol Med. 2014. 2014:621798. [QxMD MEDLINE Link]. [Full Text].
Hisanaga Y, Akaike Y, Kuroda K. Xanthoma disseminatum with large plaques confined to the back, pulmonary involvement and multiple intestinal xanthomas. Dermatology. 2004. 208(2):164-6. [QxMD MEDLINE Link].
Mountcastle EA, Lupton GP. Verruciform xanthomas of the digits. J Am Acad Dermatol. 1989 Feb. 20(2 Pt 2):313-7. [QxMD MEDLINE Link].
Kanitakis J, Euvrard S, Butnaru AC, Claudy A. Verruciform xanthoma of the scrotum in a renal transplant patient. Br J Dermatol. 2004 Jan. 150(1):161-3. [QxMD MEDLINE Link].
Reich O, Regauer S. Recurrent verruciform xanthoma of the vulva. Int J Gynecol Pathol. 2004 Jan. 23(1):75-7. [QxMD MEDLINE Link].
Griffel B, Cordoba M. Verruciform xanthoma in the anal region. Am J Proctol Gastroenterol Colon Rectal Surg. 1980 Apr. 31(4):24-5. [QxMD MEDLINE Link].
Becheanu G, Dumbrava M, Arbanas T, Diculescu M, Hoyeau-Idrissi N, Fléjou JF. Esophageal xanthoma--report of two new cases and review of the literature. J Gastrointestin Liver Dis. 2011 Dec. 20(4):431-3. [QxMD MEDLINE Link].
Atarbashi-Moghadam S, Lotfi A, Kabiri F, Sijanivandi S. Verruciform Xanthoma of the Ventral Surface of the Tongue: A Rare Case Report and Literature Review. Iran J Otorhinolaryngol. 2021 Jan. 33 (114):55-59. [QxMD MEDLINE Link].
Al Aboud AM, Al Aboud DM. Xanthelasma Palpebrarum. StatPearls [Internet]. 2021 Jan. [QxMD MEDLINE Link]. [Full Text].
Fernandes EÁ, Santos EH, Tucunduva TC, Ferrari AJ, Fernandes AD. [Achilles tendon xanthoma imaging on ultrasound and magnetic resonance imaging.]. Rev Bras Reumatol. 2014 Nov 1. [QxMD MEDLINE Link].
Griffith JF, Hu M, Yeung DKW, Guo P, Lam SL, Xiao F, et al. Achilles Tendon Xanthomas: Fat-Water Separation at Baseline and after Treatment. Radiology. 2017 Dec. 285 (3):876-884. [QxMD MEDLINE Link].
Bell A, Shreenath AP. Xanthoma. StatPearls [Internet]. 2021 Jan. [QxMD MEDLINE Link]. [Full Text].
Jin S, Chae SY, Chang SE, Suh C, Lee SW, Ryu JS. A case of xanthoma disseminatum: evaluation and monitoring by 18F-fluorodeoxyglucose positron emission tomography/computed tomography. Br J Dermatol. 2014 May. 170(5):1177-81. [QxMD MEDLINE Link].
Aldabagh B, Bergfeld W. Eruptive neutrophilic xanthomas. Dermatol Online J. 2010 Apr 15. 16(4):6. [QxMD MEDLINE Link].
Shafer WG. Verruciform xanthoma. Oral Surg Oral Med Oral Pathol. 1971 Jun. 31(6):784-9. [QxMD MEDLINE Link].
Fukuda H, Saito R. Verruciform xanthoma in close association with isolated epidermolytic acanthoma: a case report and review of the Japanese dermatological literature. J Dermatol. 2005 Jun. 32(6):464-8. [QxMD MEDLINE Link].
Inazu A, Koizumi J, Kajinami K, Kiyohar T, Chichibu K, Mabuchi H. Opposite effects on serum cholesteryl ester transfer protein levels between long-term treatments with pravastatin and probucol in patients with primary hypercholesterolemia and xanthoma. Atherosclerosis. 1999 Aug. 145(2):405-13. [QxMD MEDLINE Link].
Fujita M, Shirai K. A comparative study of the therapeutic effect of probucol and pravastatin on xanthelasma. J Dermatol. 1996 Sep. 23(9):598-602. [QxMD MEDLINE Link].
Yamamoto A, Matsuzawa Y, Yokoyama S, Funahashi T, Yamamura T, Kishino B. Effects of probucol on xanthomata regression in familial hypercholesterolemia. Am J Cardiol. 1986 Jun 27. 57(16):29H-35H. [QxMD MEDLINE Link].
Kuo PT, Hayase K, Kostis JB, Moreyra AE. Use of combined diet and colestipol in long-term (7--7 1/2 years) treatment of patients with type II hyperlipoproteinemia. Circulation. 1979 Feb. 59(2):199-211. [QxMD MEDLINE Link].
Bea AM, Perez-Calahorra S, Marco-Benedi V, Lamiquiz-Moneo I, Jarauta E, Mateo-Gallego R, et al. Effect of intensive LDL cholesterol lowering with PCSK9 monoclonal antibodies on tendon xanthoma regression in familial hypercholesterolemia. Atherosclerosis. 2017 Aug. 263:92-96. [QxMD MEDLINE Link].
Szturz P, Adam Z, Rehák Z, Koukalová R. Xanthelasma palpebrarum responding to interleukin-1 blockade. Intern Med J. 2014 Jun. 44(6):617-8. [QxMD MEDLINE Link].
Nakajima K, Ikeda M, Nakajima H, Kodama H. Regression of secondary plane xanthomas using cyclosporine A. Int J Dermatol. 2006 Sep. 45(9):1136-8. [QxMD MEDLINE Link].
Ceska R, Vrablík M, Altschmiedová T, Prusíková M, Urbanová Z, Šobra J. [Familial hypercholesterolemia - past and present. My experiences and findings in our group of patients with familial hypercholesterolemia]. Vnitr Lek. 2014 Nov. 60(11):963-9. [QxMD MEDLINE Link].
Khezri F, Gibson LE, Tefferi A. Xanthoma disseminatum: effective therapy with 2-chlorodeoxyadenosine in a case series. Arch Dermatol. 2011 Apr. 147(4):459-64. [QxMD MEDLINE Link].
Lee EH, Kang TW, Kim SC. Successful treatment of xanthoma disseminatum with simvastatin. J Dermatol. 2011 Oct. 38(10):1015-7. [QxMD MEDLINE Link].
Kim WJ, Ko HC, Kim BS, Kim MB. Successful treatment of xanthoma disseminatum with combined lipid lowering agents. Ann Dermatol. 2012 Aug. 24(3):380-2. [QxMD MEDLINE Link]. [Full Text].
Connolly SB, Lewis EJ, Lindholm JS, Zelickson BD, Zachary CB, Tope WD. Management of cutaneous verruciform xanthoma. J Am Acad Dermatol. 2000 Feb. 42(2 Pt 2):343-7. [QxMD MEDLINE Link].
Miyagawa F, Fukumoto T, Kobayashi N, Asada H. Successful treatment of diffuse normolipemic plane xanthoma with probucol. Case Rep Dermatol. 2013 May. 5(2):148-51. [QxMD MEDLINE Link]. [Full Text].
Haque MU, Ramesh V. Evaluation of three different strengths of trichloroacetic acid in xanthelasma palpebrarum. J Dermatolog Treat. 2006. 17(1):48-50. [QxMD MEDLINE Link].
Haygood LJ, Bennett JD, Brodell RT. Treatment of xanthelasma palpebrarum with bichloracetic acid. Dermatol Surg. 1998 Sep. 24(9):1027-31. [QxMD MEDLINE Link].
Lee HY, Jin US, Minn KW, Park YO. Outcomes of surgical management of xanthelasma palpebrarum. Arch Plast Surg. 2013 Jul. 40(4):380-6. [QxMD MEDLINE Link]. [Full Text].
Yang Y, Sun J, Xiong L, Li Q. Treatment of xanthelasma palpebrarum by upper eyelid skin flap incorporating blepharoplasty. Aesthetic Plast Surg. 2013 Oct. 37(5):882-6. [QxMD MEDLINE Link].
Park EJ, Youn SH, Cho EB, Lee GS, Hann SK, Kim KH, et al. Xanthelasma palpebrarum treatment with a 1,450-nm-diode laser. Dermatol Surg. 2011 Jun. 37(6):791-6. [QxMD MEDLINE Link].
Raulin C, Schoenermark MP, Werner S, Greve B. Xanthelasma palpebrarum: treatment with the ultrapulsed CO2 laser. Lasers Surg Med. 1999. 24(2):122-7. [QxMD MEDLINE Link].
Basar E, Oguz H, Ozdemir H, Ozkan S, Uslu H. Treatment of xanthelasma palpebrarum with argon laser photocoagulation. Argon laser and xanthelasma palpebrarum. Int Ophthalmol. 2004 Jan. 25(1):9-11. [QxMD MEDLINE Link].
Zhao Y, Wen CM, Zhou NN, Feng Q, Tu P. 1064-nm Q-switched Nd:YAG laser is an effective and safe approach to treat xanthelasma palpebrarum in Asian population. J Eur Acad Dermatol Venereol. 2014 Jun 9. [QxMD MEDLINE Link].
Sonthalia S, Arora R, Sarkar R. Successful cosmetic ablation of xanthelasma palpebrarum with low-voltage radiofrequency: back to the basics!. Dermatol Surg. 2014 Dec. 40(12):1443-4. [QxMD MEDLINE Link].
Esmat SM, Elramly AZ, Abdel Halim DM, Gawdat HI, Taha HI. Fractional CO2 laser is an effective therapeutic modality for xanthelasma palpebrarum: a randomized clinical trial. Dermatol Surg. 2014 Dec. 40(12):1349-55. [QxMD MEDLINE Link].
Heng JK, Chua SH, Goh CL, Cheng S, Tan V, Tan WP. Treatment of xanthelasma palpebrarum with a 1064-nm, Q-switched Nd:YAG laser. J Am Acad Dermatol. 2017 Oct. 77 (4):728-734. [QxMD MEDLINE Link].
Nguyen AH, Vaudreuil AM, Huerter CJ. Systematic review of laser therapy in xanthelasma palpebrarum. Int J Dermatol. 2017 Mar. 56 (3):e47-e55. [QxMD MEDLINE Link].
Mendelson BC, Masson JK. Xanthelasma: follow-up on results after surgical excision. Plast Reconstr Surg. 1976 Nov. 58(5):535-8. [QxMD MEDLINE Link].
Borelli C, Kaudewitz P. Xanthelasma palpebrarum: treatment with the erbium:YAG laser. Lasers Surg Med. 2001. 29(3):260-4. [QxMD MEDLINE Link].
Hsu MC, Lee CH, Chen GS, Wu CY. Nonablative 1,450-nm diode laser treatment for xanthoma disseminatum. Dermatol Surg. 2014 Dec. 40(12):1423-5. [QxMD MEDLINE Link].
Mlinaric M, Bratanic N, Dragos V, Skarlovnik A, Cevc M, Battelino T, et al. Case Report: Liver Transplantation in Homozygous Familial Hypercholesterolemia (HoFH)-Long-Term Follow-Up of a Patient and Literature Review. Front Pediatr. 2020. 8:567895. [QxMD MEDLINE Link].

Media Gallery

Xanthelasma. Courtesy of Duke University Medical Center.
Eruptive xanthomas. Courtesy of Duke University Medical Center.
Tuberous xanthomas. Courtesy of Duke University Medical Center.
Microscopic image of a xanthelasma. The lesion is composed of lipid-laden macrophages located in the superficial dermis. Courtesy of Duke University Medical Center.

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Author

Kara Melissa Torres Culala, MD Training Officer, Dermatology Department, Tondo Medical Center; Faculty, Dermatology Department, Jose R Reyes Memorial Medical Center, Philippines

Kara Melissa Torres Culala, MD is a member of the following medical societies: Philippine Dermatological Society

Disclosure: Nothing to disclose.

Coauthor(s)

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Edward F Chan, MD Clinical Assistant Professor, Department of Dermatology, University of Pennsylvania School of Medicine

Edward F Chan, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Chief Editor

Additional Contributors

Ponciano D Cruz, Jr, MD Professor and Vice-Chair, Paul R Bergstresser Chair, Department of Dermatology, University of Texas Southwestern Medical Center

Ponciano D Cruz, Jr, MD is a member of the following medical societies: Texas Medical Association

Disclosure: Received consulting fee from RCTS for independent contractor; Received honoraria from Mary Kay Cosmetics for consulting; Received grant/research funds from Galderma for principal investigator.

Acknowledgements

Kevaghn P Fair, DO Consultant Pathologist and Founder, Dominion Pathology Laboratories

Kevaghn P Fair, DO is a member of the following medical societies: American Society for Clinical Pathology, American Society of Dermatopathology, and College of American Pathologists

Disclosure: Nothing to disclose.