Xanthomas
Skin is the largest organ of the body and is frequently exposed to many toxins and chemicals. Naturally, skin is also a common site of growths, ulcers and many other kinds’ lesions. Furthermore, metabolic derangements and toxicities within the body are frequently expressed on the skin. Xanthomas are a specific kind of condition that involves the skin and are common among the general population. There are numerous reasons why these growths develop. Here we describe this pathological condition in detail, examining the many attributes of this disease to help you understand what this condition really is.
What is a xanthoma?
Basically, a xanthoma is a fatty growth that starts accumulating beneath the skin and ultimately protrudes from the surface. It can be defined as an overgrowth of xanthelasma, which are also fatty patches beneath the skin. Chronically, as the fat and lipid accumulation increases, the xanthelasma patch starts taking shape of a nodule. Now it is called a xanthoma. They are formed by the progressive accumulation of lipid-laden foam cells or histiocytes that give the lesion its characteristic pale color. Histiocytes are the macrophage cells of our immune system that are normally present in our tissues to protect us from pathogens. There are different kinds of xanthomas. Usually, these lesions indicate lipid disorders, with lipid accumulation as the primary problem.
Distribution of xanthomas
Xanthomas can be found all over the body. However, they are usually found at certain sites, which include:
- Joints, especially the elbows and the knees
- Hands
- Feet
- Buttocks
Xanthomas may be single lesions or they may appear as a cluster in an area. It may also involve only one part of the body, or it can affect different parts at once. These lesions can have different sizes and different shapes. Some people may have a xanthoma that is as small as a pinhead, whereas others can have xanthomas as large as grapes. Usually, these lesions appear as small bumps underneath the skin which may have a yellow or an orange color. The lesions can be itchy and may be slighter tender to the touch, however, often there is no pain at all.
Classification of xanthomas
There are many kinds of xanthomas. Some are differentiated due to their color or contents, others are differentiated due to their cause and still others due to the course they take. Here we describe some of the basic types of xanthomas which will help you differentiate and diagnose your condition also.
Tuberous Xanthomas
Tuberous xanthomas,These lesions are initially separate but may join together to form a cluster. They are firm, but painless are often red-yellow in color. There is a predilection for the knees, the buttocks and the heels, that is, the pressure areas of the body. These xanthomas are primarily associated with hypercholesterolemia and increased LDL levels in the blood. Studies have shown improvement in patients who attempt to reduce their blood cholesterol levels.
Tendinous Xanthomas
Tendinous xanthomas,
Tendinous xanthomas,These xanthomas are subcutaneous nodules that are associated with tendons and ligaments. They grow slowly and are most common in the hands, feet and at the Achilles tendon. The lesion is also associated with hypercholesterolemia and increased LDL in the blood.
Eruptive Xanthomas
Eruptive xanthomas,
Eruptive xanthomas,As the name sounds, these lesions are small red to yellow papules, appearing in large clusters over the buttocks, shoulders, arms, legs or even the whole body. In certain cases, the xanthomas may appear in the mouth as well. These xanthomas are usually tender and can itch and usually disappear over a few weeks. These xanthomas are caused due to hyper-triglyceridemia and are usually related to diabetes.
Plane Xanthomas
Plane Xanthomas / Xanthoma Planar
Plane Xanthomas / Xanthoma PlanarThese are the flattering variety of xanthomas which can appear anywhere on the body. However, certain areas are indicative of a particular lesion. For instance, xanthomas at the crease of the palms indicate type 3 dysbetalipoproteinemia. It may also be associated with the other fatty derangements.
Diffuse Plane Xanthomas,
These lesions are due to a rare type of macrophage. The defect results in the presence of an abnormal antibody in the blood called paraprotein. This kind of xanthoma has a strong association with cancers. In fact, studies suggest that 50% of people have the condition are also malignant. The lesions of this xanthoma large and flat and can involve the neck, face, chest, buttocks, armpits and groin.
Xanthoma Disseminatum,
Xanthoma Disseminatum
Xanthoma DisseminatumThese are xanthoma like lesions caused due to a particular kind of histiocytes. In this condition, the lipid metabolism is surprisingly normal. The skin is full of small reddish-brown bumps, hundreds in number. They tend to spread evenly, all over the body, however, they may particularly affect the armpits and groin. Some can even invade the mucosal lining of the mouth and the nose. Strangely, 40% of people afflicted with this disease develop diabetes insipidus. If worsened, it may involve the internal organs also.
What causes Xanthomas?
What causes Xanthomas?So, what is the reason behind these lesions? Why do they form and what is the link of the predisposition of certain parts of the body? Well, usually, xanthomas result from a genetic defect in lipid metabolism. Normally, lipids combine with protein to form lipoproteins, which are associated with the transportation of lipid. There are different kinds of proteins, but it’s the LDL and the VLDL that are responsible for the derangements. Many genetic defects, including hypolipoproteinemia or some other defect such as hypertension, hypothyroidism or nephrotic syndrome may be at the core of the disease. The pathogenesis involves an increasingly elevated number of lipoproteins which are taken up by tissue macrophages. They are partially digested, which results in the formation and deposition of macrophages in the skin and ultimately, xanthoma.
There are many ways of diagnosing the condition. As a small bump beneath the skin may mean anything, proper work up is required. Plus, as the disease is associated with some chronic, debilitating diseases, screening for diabetes, hypertension, and other heart diseases is of significant value. Normally, serum lipoprotein levels, blood tests, and urine tests are performed. Genetic defects can be identified by DNA profiling or by using specific serum markers.
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