Xanthelasma

Syn: Xanthelasma palpebrarum.

Xanthelasma and lipoma in Leonardo da Vinci's Mona Lisa. Isr Med Assoc J. 2004 Aug;6(8):505-6.

The painting Mona Lisa in the Louvre, Paris, by Leonardo da Vinci (1503-1506), shows skin alterations at the inner end of the left upper eyelid similar to xanthelasma, and a swelling of the dorsum of the right hand suggestive of a subcutaneous lipoma. These findings in a 25-30 year old woman, who died at the age of 37, may be indicative of essential hyperlipidemia, a strong risk factor for ischemic heart disease in middle age. As far as is known, this portrait of Mona Lisa painted in 1506 is the first evidence that xanthelasma and lipoma were prevalent in the sixteenth century, long before the first description by Addison and Gall in 1851

Xanthelasma is the most common form of xanthoma and is characterized by one or more yellowish plaques on the eyelid or in the periorbital skin.

Most patients are in the 5th or 6th decade of life.

Lipid levels are normal in about 50% of the patients. In some young patients there is higher incidence of hypercholesterolemia.

Microscopic features: There are small aggregates of large, pale staining foam cells in the upper dermis. Inflammatory cells are not present. There is no fibrosis.

These are usually removed for cosmetic reasons.

Visit: Verruciform Xanthoma ; Gastric Xanthoma.

Abstracts:

Internist's view on skin manifestations of hyperlipidemia in diabetic patients.Vnitr Lek. 2006 May;52(5):465-9

Xanthoma and xanthelasma are typical symptoms of lipid and lipoprotein metabolism impairment. On the basis of their incidence and morphology, it is even possible to specify the impairment type. Hypercholesterolemia or certain liver dysfunctions are characterized by slow development of surface xanthelasmas usually located on mechanically stressed regions (e.g. eyelids). Tuberous and tendinous xanthomas are typical for familiar hypercholesterolemia and are common symptoms of homozygous familiar hypercholesterolemia. Small and quickly developing eruptive xanthomas are typical for mixed hyperlipoproteinemia (secondary hyperlipoproteinemia is typical for diabetes). Mechanism of accumulation of lipids in skin morphs is similar to the development of atheroma, especially when talking about the role of modified LDL and the way of accumulation of lipids in macrophages. The following factors are very important for etiopathogenesis of skin xanthomas development: mechanical stress of tissues, increased permeability of skin capillaries and reaction of proteoglycans in sparse connective tissue. Xanthomas and xanthelasmas are typical indicators of other complicating diseases as e.g. development of acute pancreatitis during hyperlipoproteinemic crisis, aggravation of insulin resistance, and decompensation of type 2 diabetes mellitus. The therapy focuses on adjustment of dietary regime (elimination of dietary fat and concentrated saccharides); no food and sufficient hydration via infusion of crystalloid solutions is indicated in cases of serious hyperlipoproteinemic crisis. In vital indication, it is possible to perform repeated plasmapheresis (or better continual plasmapheresis) that can correct even serious hyperlipoproteinemic crises within several hours. And what is more, continual plasmapheresis can significantly reduce the period when hyperlipoproteinemic crisis might induce acute necrotizing pancreatitis. In the long run, we require that patients strictly observe their dietary regime based on the type of hyperlipoproteinemia. As for medicamentous therapy, fibrates and atorvastatin (from statin family) are the preparations of choice. It is very important not to focus on symptoms, i.e. xanthoma or xanthelasma, but fully compensate lipid metabolism impairment or the disease that underlies hyperlipoproteinemia (e.g. type 2 diabetes mellitus or metabolic syndrome). Unfortunately, it still can be seen that dermatologists, ophthalmologists or plastic surgeons remove extensive xanthelasmas, while the underlying cause is not approached diagnostically and therapeutically at all.

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Normolipemic papular xanthoma with xanthelasma. Dermatol Online J. 2006 Mar 30;12(3):19.

Xanthomas are a common presentation of disorders of lipid metabolism, usually associated with abnormalities of cholesterol metabolism. A 35-year-old woman presented to us with the lesions of xanthelasma on the upper eyelids and papular xanthomas on the rest of the body. Routine investigations and systemic examination were normal. The lipid profile was within normal range and serum protein electrophoresis showed normal pattern. Histopathology from a papular lesion showed foamy histiocytes with Touton giant cells. We present a case of normolipemic papular xanthoma with xanthelasma, a very rare occurrence.