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Landau M, Klein J, Leizgold FR, Kroumpouzos G. Rare and novel complications of botulinum neurotoxin type A and dermal filler injections. Clin Dermatol 2024:S0738-081X(24)00107-X. [PMID: 38914174 DOI: 10.1016/j.clindermatol.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Botulinum neurotoxin type A (BoNTA) and filler injection procedures usually provide predicted outcomes with a low incidence of complications. Most of the complications after these procedures have been extensively discussed. In this study, we report on these injectables' less well-known, recently reported, and novel complications and attempt to clarify the underlying mechanisms. Counterfeit or mishandled BoNTA has been associated with botulism. BoNTA has been linked to uncommon complications, including morphea-like lesions, nontuberculous mycobacterial infections, vascular occlusion, and pseudoaneurysm of the superficial temporal artery. Unusual complications from filler injection include nonscarring alopecia, intraoral necrosis, nontuberculous mycobacterial infections, xanthelasma-like reactions, intracranial perforation, and pneumosinus dilatans. Post-BoNTA injection nodules and filler infection from bone destruction due to cocaine use are new complications. These complications pose a challenge for diagnosis and treatment. This publication aims to assist in promptly identifying and managing these rare and novel complications when necessary.
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Affiliation(s)
| | - Jerome Klein
- Jules Stein Eye Institute, UCLA Medical Center, Los Angeles, California, USA
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2
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Ergun SB, Kurt B. Complete Blood Cell Count-Derived Inflammation Biomarkers in Patients with Xanthelasma Palpebrarum. BEYOGLU EYE JOURNAL 2024; 9:33-37. [PMID: 38504961 PMCID: PMC10944854 DOI: 10.14744/bej.2024.48802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/25/2024] [Accepted: 01/31/2024] [Indexed: 03/21/2024]
Abstract
Objectives Xanthelasma palpebrarum (XP) is the most common type of cutaneous xanthoma, characterized by yellowish cutaneous plaques commonly located near the medial canthus of the eyelid. Although dyslipidemia significantly contributes to its development, inflammation is also believed to be another element in the pathogenesis, especially in normolipidemic patients. Recently, cell counts derived from complete blood counts have been identified as indicators of systemic inflammatory conditions and have also been under discussion concerning their relevance to ocular diseases. This study aimed to assess inflammation indices derived from complete blood cell counts (CBC) in XP patients with normal lipid levels. Methods Patients who had been referred to the oculoplasty department with the diagnosis of XP between January 2020 and January 2023 and age-matched control subjects were retrospectively reviewed. Patients who had abnormal lipid profiles and systemic diseases such as diabetes mellitus, hypertension, malignancy, cardiovascular diseases, systemic infections, and inflammatory diseases were not included in the study. CBC parameters were analyzed and compared between the groups. Results The study comprised 27 normolipidemic patients with XP and 27 age-matched healthy individuals as the control group. There were no statistically significant differences between the two groups in terms of age (p=0.143). The mean hemoglobin, neutrophil, monocyte, lymphocyte, platelet, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, and aggregate index of systemic inflammation values were higher in the patient group, but the differences were not statistically significant (p>0.05). The mean red cell distribution width and platelet-to-lymphocyte ratio appeared to be lower in the patient group compared to the control group; however, no significant differences were observed between the two groups (p=0.272, p=0.387, respectively). Conclusion This study might offer insights into the pathogenesis of XP, yet numerous questions remain unanswered, awaiting further investigation in future studies.
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Affiliation(s)
- Sule Berk Ergun
- Department of Ophthalmology, Ankara City Hospital, Ankara, Türkiye
| | - Busra Kurt
- Department of Ophthalmology, Ankara City Hospital, Ankara, Türkiye
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Eppley SE, Silkiss RZ. Bilateral primary orbital xanthogranulomas: A case report and comparison of xanthomatous conditions. J Clin Lipidol 2023; 17:587-591. [PMID: 37716832 DOI: 10.1016/j.jacl.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/26/2023] [Accepted: 08/03/2023] [Indexed: 09/18/2023]
Abstract
This report describes an unusual and diagnostically challenging case of subcutaneous soft tissue xanthogranulomas of bilateral orbits of a 58-year-old female patient seen in a private oculoplastics practice. Accurate and timely diagnosis is crucial in xanthogranulomatous diseases so that any systemic manifestations can be identified and addressed in a multidisciplinary fashion. Periorbital xanthogranuloma is a frequent early manifestation of adult xanthogranulomatous disease, and its association with life-threatening systemic disease requires accurate diagnosis and prompt work-up. This case describes an otherwise asymptomatic patient who presented with bilateral orbital masses causing visually significant ptosis, initially diagnosed as soft tissue xanthomas, and later identified as xanthogranulomas. It is important for physicians of all fields, from primary care to surgical subspecialty, to be aware that xanthogranulomatous disease may first present as periorbital lesions and/or orbital masses, and that further work-up for vision and life-threatening systemic disease is warranted.
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Affiliation(s)
- Sarah E Eppley
- California Pacific Medical Center, Department of Ophthalmology, 711 Van Ness Ave Suite 250, San Francisco, CA, 94102, USA.
| | - Rona Z Silkiss
- California Pacific Medical Center, Department of Ophthalmology, 711 Van Ness Ave Suite 250, San Francisco, CA, 94102, USA
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Azendour H, Alami S, Meziane M, Ismaili N, Benzekri L, Senouci K. Treatment of xanthelasma palpebrarum with intralesional heparin sodium: a pilot study. Int J Dermatol 2023; 62:e124-e125. [PMID: 36371701 DOI: 10.1111/ijd.16509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/21/2022] [Accepted: 11/01/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Hasna Azendour
- Department of Dermatology, Mohammed V University of Rabat, Ibn Sina Hospital, Rabat, Morocco
| | - Sofia Alami
- Department of Dermatology, Mohammed V University of Rabat, Ibn Sina Hospital, Rabat, Morocco
| | - Mariame Meziane
- Department of Dermatology, Mohammed V University of Rabat, Ibn Sina Hospital, Rabat, Morocco
| | - Nadia Ismaili
- Department of Dermatology, Mohammed V University of Rabat, Ibn Sina Hospital, Rabat, Morocco
| | - Laila Benzekri
- Department of Dermatology, Mohammed V University of Rabat, Ibn Sina Hospital, Rabat, Morocco
| | - Karima Senouci
- Department of Dermatology, Mohammed V University of Rabat, Ibn Sina Hospital, Rabat, Morocco
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Dabas R, Das N, Subramaniyan R, Arora S, Janney M, Lal S. Efficacy of ultrapulse carbon dioxide laser ablation versus 30% trichloroacetic acid in xanthelasma palpebrarum - A randomised controlled trial. JOURNAL OF MARINE MEDICAL SOCIETY 2021. [DOI: 10.4103/jmms.jmms_80_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rallidis LS, Iordanidis D, Iliodromitis E. The value of physical signs in identifying patients with familial hypercholesterolemia in the era of genetic testing. J Cardiol 2020; 76:568-572. [PMID: 32741655 DOI: 10.1016/j.jjcc.2020.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 11/25/2022]
Abstract
Familial hypercholesterolemia (FH) is a common, inherited disorder of cholesterol metabolism characterized by very high plasma concentrations of low-density lipoprotein cholesterol. It is crucial to diagnose and treat this disorder early since if left untreated it increases the risk for coronary artery disease (CAD) at least by 10-fold. Although genetic testing for FH, when available and affordable, should ideally be offered to most individuals with clinical phenotype suggestive of FH, it is underutilized in most countries. Therefore, FH diagnosis in the majority of cases is made by combining cholesterol levels and clinical characteristics of the patient leaving the need for genetic testing usually in equivocal cases. The presence of some cutaneous and ocular signs can raise the suspicion or even lead to the diagnosis of FH among usually "healthy" individuals. These physical signs comprise cutaneous lesions such as tendon xanthomas or the less specific xanthelasmata and ocular signs, such as corneal arcus in individuals under the age of 45 years. The presence of these signs should prompt the physician to request lipid tests and use clinical scores to diagnose FH. If the diagnosis of FH is likely, aggressive lipid-lowering therapy should be initiated to reduce the risk of CAD and a cascade screening of family members should also be requested.
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Affiliation(s)
- Loukianos S Rallidis
- Second Department of Cardiology, University General Hospital, "Attikon", Athens, National and Kapodistrian University of Athens, Athens, Greece.
| | - Dimitrios Iordanidis
- Second Department of Cardiology, University General Hospital, "Attikon", Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Iliodromitis
- Second Department of Cardiology, University General Hospital, "Attikon", Athens, National and Kapodistrian University of Athens, Athens, Greece
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Béland K, Wong E, St-Cyr JF, Lair S. High occurrence rate of xanthomatosis and nephrocalcinosis in aquarium-housed Atlantic wolffish Anarhichas lupus and spotted wolffish A. minor. DISEASES OF AQUATIC ORGANISMS 2020; 139:223-232. [PMID: 32495748 DOI: 10.3354/dao03477] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Atlantic wolffish (AW) and the spotted wolffish (SW) are long-lived fish found in the North Atlantic and Arctic oceans and are respectively classified as special concern and threatened species, mainly due to fisheries bycatch. To better understand health issues associated with the care of these species in public aquaria, reports from all necropsies performed in 2 zoological institutions between 2009 and 2019 were reviewed (31 AW and 8 SW). These wolffish were fed with a similar fish-based diet and kept in multi-species exhibits with comparable environmental parameters. The most frequent necropsy findings were the presence of xanthomas (AW: 41.9%; SW: 75.0%), nephrocalcinosis (AW: 42.9%; SW: 75.0%) and urocystoliths (AW: 6.5%; SW: 62.5%). Xanthomas were mostly located at the base of pectoral fins and were characterized by extensive granulomatous inflammation centered on accumulations of partly mineralized degenerate fatty material, mainly composed of cholesterol crystals. Nephrocalcinosis was characterized by the deposition of calcium salts within the renal tubules and was commonly associated with tubular necrosis. The aquarium-housed wolffish were fed a coldwater fish-based diet. However, the natural diet of wolffish is composed mostly of invertebrates such as urchins and crustaceans. Differences in nutrient composition between these diets, such as lipid and mineral content, may have contributed to the development of xanthomatosis, nephrocalcinosis and urocystolithiasis in wolffish housed in these institutions.
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Affiliation(s)
- Karine Béland
- Centre québécois sur la santé des animaux sauvages/Canadian Wildlife Health Cooperative, Faculté de médecine vétérinaire, Université de Montréal, St. Hyacinthe, Quebec J2S 8H5, Canada
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Lin X, Hu H, Qian Y, Jie X, Nie B, Zhao YZ, Wang H, Jiang H. Intralesional injection of bleomycin in the treatment of xanthelasma palpebrarum: A clinical study. J Cosmet Dermatol 2020; 19:2125-2130. [PMID: 31930760 DOI: 10.1111/jocd.13258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/14/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Xanthelasma palpebrarum (XP) is the most common type of cutaneous xanthoma and has been treated with intralesional injection of pingyangmycin effectively. However, bleomycin, which has the same effect in antitumor activity as pingyangmycin, has not been applied in the treatment of XP. AIMS To explore and assess the treatment of xanthelasma by intralesional injection of bleomycin, which has been widely used as an antitumor antibiotic, for the replacement of pingyangmycin. METHODS Intralesional injection of different concentrations of bleomycin was administered to 44 xanthelasma lesions of 24 patients who have never been treated before, divided into two groups according to age. Photographs were taken and analyzed to assess the therapeutic efficiency. Patients were then followed up for 6-24 months. RESULTS All the lesions resolved after 1 month of treatment with the intralesional injection of different concentrations of bleomycin. There was no significant difference observed between the two groups. No severe complications had occurred. CONCLUSION The treatment of XP with intralesional injection of bleomycin is minimally invasive, safe, and effective. Consequently, it also has good cosmetic outcome with no adverse effects.
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Affiliation(s)
- Xianzheng Lin
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Hao Hu
- Postdoctoral Station of Clinical Medicine, East Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Plastic and Reconstructive Surgery, East Hospital, Tongji University, Shanghai, China
| | - Yuxin Qian
- Department of Plastic and Reconstructive Surgery, East Hospital, Tongji University, Shanghai, China
| | - Xiang Jie
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Bing Nie
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Yao-Zhong Zhao
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai, China
| | - Hui Wang
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai, China.,Department of Plastic and Reconstructive Surgery, East Hospital, Tongji University, Shanghai, China
| | - Hua Jiang
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Navy Medical University (Second Military Medical University), Shanghai, China.,Department of Plastic and Reconstructive Surgery, East Hospital, Tongji University, Shanghai, China
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Jakobiec FA, Ma L, Wolkow N, Sutula FC, Freitag SK. The Significance of Extracellular Cholesterol Crystals or a Cholesterol Granuloma in Xanthelasma. Ocul Oncol Pathol 2018; 4:345-354. [PMID: 30574485 DOI: 10.1159/000486532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 12/20/2017] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Xanthelasma is an unreliable indicator of systemic hyperlipidemia. A review in search of unusual histopathologic features of cellular composition that might correlate with systemic hyperlipidemia was conducted. Methods An observational case series of 3 cases was performed. Slides were stained and analyzed with hematoxylin and eosin, Masson trichrome, and periodic acid-Schiff as well as for iron. Three lesions displayed an atypical morphologic finding and were subjected to immunohistochemical analysis for CD3, CD20, CD68, CD163, S100, and adipophilin. Results The three lesions comprised in this study had classical xanthoma cells with densely packed fine vacuoles. The xanthoma cells were CD68, CD163, and adipophilin positive and S100 negative. In case 1, extracellular, nonpolarizing cholesterol crystalloids displayed totally negative staining for all biomarkers. In cases 2 and 3, the cholesterol granulomas were surrounded and permeated by CD68- or CD163-positive epithelioid and giant cells and by CD3-positive T lymphocytes. The 3 cases each harbored squamous cysts. Conclusion In case 1, the uninflamed extracellular cholesterol crystalloids were associated with severely dysregulated systemic hyperlipidemia. In cases 2 and 3, the cholesterol granulomas were interpreted as a local manifestation of a cyst that might have partially ruptured and did not portend serious hyperlipidemia.
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Affiliation(s)
- Frederick A Jakobiec
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Lina Ma
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Wolkow
- David G. Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Francis C Sutula
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Suzanne K Freitag
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA.,Ophthalmic Plastic Surgery Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
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