Zur Morphogenese des Xanthelasma palpebrarum

IMMUNOHISTOCHEMICAL STUDY OF HUMAN XANTHOMA

Specimens of human tuberous xanthomas obtained from two hyper-beta-lipoproteinemic patients were prepared with HE and Sudan III stain and by direct immunofluorescence with fluorescein isothiocyanate labeled antihuman beta-lipoprotein rabbit serum. In some histiocytes and foam cells in early stages, lipids were stained in granular patterns and specific fluorescence was observed. In some foam cell nests, specific fluorescence was weak or absent, and orange-colored lipid autofluorescence was present. The foam cells in such nests were probably late foam cells and corresponded to the large cytoplasmic foam cells stained densely and amorphously for lipids. It was concluded that at early stages of xanthoma formation, serum lipoproteins were incorporated into dermal histiocytes and early foam cells. The apoproteins of the incorporated lipoproteins were probably degraded and lipid residues accumulated in the cells. Specimens of tuberous xanthoma covered by plane xanthoma showed lipids and bright specific fluorescence at the basement membrane zone. A faint fluorescence was observed in the upper dermis and even in parts of the epidermal intercellular spaces.

Treatment of xanthelasma palpebrarum with the pulsed dye laser

BACKGROUND OF OBJECTIVE: Treatment of xanthelasma palpebrarum may prove difficult due to its delicate location at the periorbita and its sometimes extensive dimension. During recent years, carbon dioxide and argon lasers have been used with good results. However, local anesthesia is always required, and there is a concrete risk of scarring and pigmentation changes after the treatment.

STUDY DESIGN/PATIENTS AND METHODS

In this case report, we describe for the first time the treatment of xanthelasmas with the pulsed dye laser.

RESULTS

This technique can be carried out without anesthesia and shows excellent cosmetic results.

CONCLUSION

We see the pulsed dye laser as a good alternative to the hitherto used other two laser types in the treatment of xanthelasma palpebrarum.

Bilateral and extensive xanthelasma palpebrarum in a young man

A 25-year-old white man had been aware since childhood of yellow discolorations of the medial aspects of his upper lids. The skin changes progressively spread to involve all four eyelids, the inferior skin of the brow, and the lateral and medial canthal skin. The clinical diagnosis was extensive bilateral xanthelasmas . The patient had no manifest abnormality of lipid metabolism, although his father and grandfather had both developed xanthelasmas early in childhood. A snip biopsy of upper lid skin was performed and studied by both light and electron microscopy. The light microscopic appearance confirmed the diagnosis of xanthelasma, in that the upper dermis contained mono- and multinucleated foamy xanthoma cells beset with myriad cytoplasmic vacuoles. Cells displaced outwardly into the interstitium evidenced degradation phenomena within the vacuoles, consisting of lamellar bodies or fingerprint-like inclusions, presumably the result of fusion of lysosomes with the lipidic inclusions. Scattered non- lipidized mononuclear histiocytes with abundant profiles of smooth-surfaced endoplasmic reticulum possibly represented a reserve population of monocytes for conversion into xanthoma cells.

[Erythema elevatum diutinum. I. Electron microscopy of a case with extracellular cholesterosis (author's transl)]

1. A typical case of Erythema elevatum diutinum (E.e.d.) with extracellular cholesterosis is described clinically and histologically in a 48-year-old woman. The disease had a course of 15 years. 2. Electron microscopy confirmed the histological and immunfluorescent findings of leucocytoclastic vasculitis. In older lesions, histiocytes/macrophages predominate. Intra- and extracellular lipid depositions showed a variety of ultrastructural characteristics which differed from electron microscopical findings described in other disorders associated with lipid deposition. 3. The findings are in accordance with the hypothesis that the primary event in E.e.d. is a special type of chronic leukocytoclastic vasculitis. Subsequently, the damage of the vessel walls and focal necrosis may lead to secondary lipid deposition.