Eruptive xanthomas

Prompt Cytopathological Diagnosis of Multiple Xanthomatous Skin Nodules in an Adolescent Girl Opening the Doors to Detection of Familial Hypercholesterolemia

BACKGROUND

Xanthomas are papulo-nodular, yellow, soft, painless, dermal-based non-neoplastic cutaneous lesions that comprise of localized aggregates of lipid-laden histiocytes.

CASE REPORT

A thirteen-year-old adolescent girl presented with multiple, large, bilateral, nodules present over elbows, posterior aspect of heel, and knees for five years. Fine needle aspiration cytology was performed, and the smears showed numerous foamy histiocytes, a few benign spindle cells, and foreign-body giant cells against a lipidaceous background. Her maternal aunt and grandmother also had xanthelasma palpebrarum. Serum lipid levels were advised and were markedly deranged in all three of them. Based on the corroborative clinical, biochemical, and cytopathological findings, a final diagnosis of familial hypercholesterolemia (FH) was rendered.

CONCLUSION

The present case sheds light on the importance of prompt cytopathological diagnosis of xanthomatous lesions, especially in children and adolescents, as it can help prevent morbidity and mortality due to associated premature adverse cardiovascular and cerebrovascular events if left undiagnosed.

An Unusual Case of Xanthoma of Bilateral Achilles Tendon with Gouty Infiltration: A Rare Case Report

Achilles tendon xanthoma is a benign and rare disease with a high incidence in patients having familial hypercholesterolemia. Patients present with or without pain and thickened tendons. Gout is seen in patients with hyperuricemia. Coexistence of xanthoma and gout is extremely rare. We searched the PubMed literature with ‘Xanthoma’ and ‘Gout’ as keywords and could find only one case report. Imaging modalities such as radiography and ultrasonography, play a vital role in diagnosing this condition early, hence helping the patient to commence the use of potentially lifesaving lipid-lowering therapeutic agents. Magnetic resonance imaging is helpful in delineating the morphological changes, exact measurements, and eventually in treatment planning. It helps to rule out early involvement of other tendons by the same pathology. We present a case of a 25-year-old male patient who presented to our institute with bilateral large symmetrical swelling in the posterior aspects of ankles for 4 years, with normal serum and blood parameters. Bilaterality, enormous size and normal blood and serum parameters make this case unique.

Skin Grafting, Cryopreservation, and Diseases: A Review Article

Food supplements may be consumed through diet and have been shown to modify skin functions, making them helpful in the management of skin aging. However, there are not many clinical trials that back up these assertions. The stratum corneum, which acts as the organism's contact with its environment, is the principal function of the epidermis of land vertebrates. Antioxidants are chemicals that slow down or prevent other molecules from oxidizing. In people's diets, their use has considerably expanded in recent years. Due to their benefits for health, nutrition, and therapy, natural antioxidants are increasingly being used in place of synthetic antioxidant components. A popular component thought to be an antioxidant is hydrolyzed collagen. With aging comes a steady loss of physiological integrity, capacity to handle stress from the inside out, and function. This is a byproduct of several intricate biological processes that are affected by diseases both local and systemic as well as constitutive and environmental variables. Systemic and constitutive (genetic) variables influence skin aging and its phenotypic manifestation. The biological process of skin aging is complicated and impacted by both external and endogenous causes. The primary contributor to skin cancer is sun exposure. Ultraviolet radiation from the sun can kill skin cells by directly absorbing DNA damage. The skin's hydration is a crucial factor that affects its mechanical and physical characteristics. This study looks at how the stratum corneum's molecular and macroscopic characteristics interact and change with skin wetness. Although there is little information written about them and even less is understood about them, moisturizers are a crucial component of a dermatologist's toolkit. There is a plethora of anticipated skin products on the market, but their true scientific function is yet unknown. These items play a well-known part in many skin problems, while occasionally being dismissed as simple cosmetics.

Eruptive xanthomas as a marker for metabolic disorders: A specific form of xanthoma that reflects hypertriglyceridemia

Eruptive xanthomas are skin manifestations associated with hypertriglyceridemia. Accordingly, the improvement of hypertriglyceridemia can ameliorate this condition. We report a case of a patient with type 2 diabetes mellitus who was diagnosed with this skin lesion. Clinicians should be aware that eruptive xanthomas could indicate metabolic disorders associated with atherosclerosis.

Eruptive Xanthomas: Importance of Recognition to Reduce Delay of Effective Triglyceride Reduction

Eruptive xanthomas are localized lipid deposits in the dermis and an important early clue to severe hypertriglyceridemia. These small erythematous or yellow papules that localize to the extensor surfaces of extremities, buttocks, and the back are often overlooked during routine visits secondary to poor familiarity and limited skin examinations. We present 3 cases of patients with eruptive xanthomas and severe hypertriglyceridemia who underwent skin biopsy and waited weeks to years before receiving effective treatment. We suggest the following to minimize the delay between presentation and effective management. First, perform a comprehensive skin examination. Second, be mindful of the association between metabolic syndrome or diabetes with severe hypertriglyceridemia. Third, evaluate the Four D's of secondary hypertriglyceridemia: Diet/Lifestyle, Drugs/Medications, and Diseases/Disorders of metabolism. Finally, initiate effective treatment promptly after recognition. This includes beginning with a minimal fat diet and appropriate pharmacological intervention to control triglycerides as outlined in recent guidelines.

The Role of Atorvastatin in Management of Eruptive Xanthoma on a Boy: A Case Report

Background: Eruptive xanthoma is a benign skin lesion caused by the accumulation of cholesterol and triglycerides in the skin's dermis. Xanthoma can be an early clinical manifestation of systemic diseases such as dyslipidemia, cardiovascular disease, diabetes mellitus. Clinical presentation varies from asymptomatic skin lesions to intense pruritus and tenderness. Aim: This study aims that oral atorvastatin is effective in treating a child with eruptive xanthoma. Case report: A three-year-old boy with an 8.4 kg body weight and 82.5 cm height came to the hospital with the chief complaint of small yellowish-white papules and nodes, discrete, 2-5 mm in size, painless on pressing, itchy, scattered, mainly in the lower extremity around the buttocks. On laboratory examination, Hb 11.5 g/dL, leukocyte 9,900/ul, platelet 413,000/uL, blood glucose 66 mg/dL. Further evaluation revealed total cholesterol 814 mg/dL, LDL 970 mg/dL, HDL 341 mg/dl, triglycerides 621 mg/dL; there is no evidence of familial hypercholesterolemia. The diagnosis is eruptive xanthoma.  After starting treatment with atorvastatin 0.2 mg/kg body weight/day in one dose for six months, his cutaneous lesions gradually subsided and significantly decreased cholesterol, LDL, HDL, and triglyceride levels. Conclusion: Early therapy with atorvastatin will reduce the morbidity and mortality of eruptive xanthoma.

Giant Intracranial Xanthoma with Cloudy Vision as the First Symptom: A Case Report and Literature Review

A 31-year-old male with mild dizziness complained of cloudy vision in his right eye for 5 days. The visual acuity of both eyes was normal, while the visual contrast sensitivity of both eyes slightly reduced. Fundus examination showed the swollen and radial superficial hemorrhage of his both optic nerves. Brain MRI scan indicated a huge tumor in the right temporal lobe with clear boundary, close to the skull. The midline structure shifted to the left. Blood tests indicated no hyperlipidemia or lipid disorders. The patient then received tumor resection. The size of the tumor was 5.6 cm × 7.5 cm × 10.1 cm. Histology suggested many foam cell accumulations and the tumor was positive for CD34, CD99, Vimentin, β-Catenin and CD68, but negative for EMA, GFAP, IDH-1, Oliga-2, PR, S-100, and CD1a. Three months after surgery, MRI showed the midline structure was back to normal. The swollen and radial superficial hemorrhage of optic nerves had disappeared. The visual acuity and visual field remained normal.

Infantile systemic juvenile xanthogranuloma case with massive liver infiltration

Infantile systemic juvenile xanthogranuloma (ISJXG) is an uncommon form of juvenile xanthogranuloma, a non-Langerhans cell proliferation of infancy and early childhood. In a small percentage of patients, the visceral involvement—most commonly to the central nervous system, liver, spleen, or lungs—may be associated with severe morbidity, and eventually fatal outcome. Here we describe the clinical and pathological findings of a 28-day-old girl with ISJXG who died with respiratory distress syndrome. She had few cutaneous lesions but massive liver and spleen infiltration; other affected organs were multiple lymph nodes, thoracic parasympathetic nodule, pleura, pancreas, and kidneys. Additional findings were mild pulmonary hypoplasia and bacteremia. Immunohistochemistry on fixed tissues is the standard for diagnosis. Immunophenotype cells express CD14, CD68, CD163, Factor XIIIa, Stabilin-1, and fascin; S100 was positive in less than 20% of the cases; CD1a and langerin were negative. No consistent cytogenetic or molecular genetic defect has been identified. This case demonstrates that the autopsy is a handy tool, because hepatic infiltration, which was not considered clinically, determined a restrictive respiratory impairment. In our opinion, this was the direct cause of death.

An unusual presentation of eruptive xanthoma: A case report and literature review

BACKGROUND

Eruptive xanthomas are benign skin lesions caused by localized deposition of lipids in the dermis. The lesions are generally caused by elevated levels of serum triglycerides that leak through the capillaries and are phagocytosed by macrophages in the dermis. Clinical manifestation varies from asymptomatic skin lesions to intense pruritus and tenderness.

METHODS

We present a case of a middle-aged man admitted with diabetic ketoacidosis secondary to noncompliance with insulin. He was found to have skin lesions as multiple crusted papules on the extremities. Further evaluation revealed elevated serum triglycerides. A diagnosis of eruptive xanthomas was made on skin biopsy, and after starting treatment with lipid lowering agents his cutaneous lesions gradually subsided.

CONCLUSION

Appearance of eruptive xanthomas can signify the onset of serious complications. Prompt recognition of such skin manifestations is warranted to prevent development of fatal medical condition like coronary artery disease and pancreatitis.

Juvenile xanthogranuloma: a rare benign histiocytic disorder

Juvenile xanthogranuloma (JXG) is a rare histiocytic disorder that typically affects children. The clinical presentation of this disease is characterized by single or, rarely, multiple yellow and brown skin nodules, most often found on the face and neck. Internal organ involvement has been sporadically observed in JXG and is associated with an increased risk of serious complications. We report two cases with a small and large nodular form of JXG.