A Clinical and Histopathological Study of Xanthomas / 대한피부과학회지

ABSTRACT

BACKGROUND: Xanthomas consist of localized infiltrates af lipid-containing histiocytic foam cells that are usually found within the dermis or tendons. They frequently arise in the presence of a disturbance of lipid metaholism. OBJECTIVE: The purpose of this study was to elucidate the clinical and histopathological characteristics of xanthomas. METHODS: Eighteen cases of xanthoma confirmed clinically and histopathologically were ana lyzed. Xanthelasma was excluded in this study. RESULTS: The results were summarized as follows. 1. The incidence of xanthoma was 0.03% of the total number of dermatologic patients. 2. The ratio between male and female was 12.6 and the age distribution varied from 2 to 65 years old(mean age 37.4 years-old), and the distribution of age of onset was from birth to 62 years old(mean age of onset 32.9 years old). 3. The frequencies of elinical types, in descending order, were xanthoma tuberosum(XT) 44.4%, xanthoma planum(XP) 27.8%, Xanthoma eruptivum(XE) 22.2%, and xanthoma striatum palmare (XSF) 5.6 %. 4. The common sites were the knee, elbow and buttock in XT; The upper and lower extremities in XE, the cheek, neck and chest in XP; palmar creases in XSP. 5. Serum lipid abnormalities were detected in 88.9%(16/18). 6. The associated diseases were hypothyroidism, diabetes, hepatomegaly, psoriasis. 7. A family history was significant in 2 patients with XT. 8. The associated hyperlipoproteinemia was type IIa(4/8), IIb(2/8), III(1/8), IV(1/8) in XT, type IIa(2/5), IV(2/5) and normolipoproteinemia(1/5) in XP, type I(1/4), IV(1/4), V(1/4) and normolipoproteinmia(1/4) in XE, type III(1/1) in XSP, respectively. 9. Diet, alone or combination with antilipidemic drugs were used for treatment, and the lesions were cleared in 2(one XP and one XE) of 7 patients that could be followed up. 10. Histopathological features revealed that lipid-laden foamy histiocytes were observed in all cases of xanthomas and foreign body giant cells were more common than Touton giant cells. CONCLUSION: Xanthomas were not so common disorders compared with the incidence of hyperlipoproteinemia and were more common in females than males. The most common clinical type was XT except for xanthelasma. The most common associated hyperlipoproteinemia in each type of xanthoma was type II in XT, type IIa and IV in XP, variable types in XE, type III in XSP, respectively. Lipid-laden foamy histiocytes were observed in all cases of xanthomas and for eign body giant cells were more common than Touton giant cells.