Xanthomas: a marker for hyperlipidemias

Xanthomas are deposits of lipids in the skin and sometimes of the subcutaneous tissue that are expressed clinically as yellowish papules and plaques, nodules, and tumors. They are often, but not always, a consequence of hyperlipidemia. In these cases, a meticulous work-up nearly always reveals some disturbance in regards to the metabolism of the lipids-lack of certain lipoproteins, for example. Xanthoma tuberosum and tendinosum occur in persons with familiar hypercholesterolemia, palmar crease xanthoma in familial dysbetalipoproteinemia, plane xanthoma in persons with an underlying lymphoproliferative disorder (or normolipemic), and eruptive xanthoma in those with a genetically-transmitted lipoprotenemia. In sum, each type of xanthoma and any associated abnormality in lipid metabolism can be diagnosed with specificity. Xanthomas are deposits of lipid in the skin or subcutaneous tissue that manifest clinically as yellowish papules, nodules and tumors. They are often associated with hyperlipidemias, although some of them may be normolipemic. Xanthomas result when abnormalities in the transportation of lipids such as cholesterol, triglycerides and phospholipids cause these lipids to be deposited in the skin and being ingested by tissue macrophages. When they are deposited in the walls of arteries, they promote the development of atherosclerosis. Sometimes, by identifying the clinical variant of the xanthoma, the lipoprotein that is deposited and the clinical associations can be predicted. This discussion will focus on those xanthomas associated with hyperlipidemias

Organ-specific autoantibodies in vitiligo patients and their relatives.

BACKGROUND: Recent data have supported an autoimmune etiology of vitiligo. Genetic factors also seem to play an important role in this disorder. The purpose of this study was to determine the presence and frequency of organ-specific autoantibodies in vitiligo patients and their relatives. METHODS: Twenty patients with vitiligo and two first or second degree relatives of each patient were interviewed and their sera analyzed for the presence of antithyroglobulin (ATg), antithyroid microsomal (ATM), antiparietal cell (APC), and antiadrenal (AAd) autoantibodies. The sera of 20 normal patients were used as control. RESULTS: A significantly increased frequency of ATg, ATM, and APC antibodies was found in vitiligo patients when compared to normal controls. First and second degree relatives had significantly increased frequencies of ATg and ATM. A high incidence of autoimmune/endocrine diseases was found in the patients' relatives, including a 25% prevalence of vitiligo. CONCLUSIONS: These findings not only support an autoimmune etiology for vitiligo, but also highlight the strong genetic contribution to this pigmentary disorder.

The spectrum of cutaneous lesions in pediatric patients with leukemia.

This is a clinical study that attempts to determine the incidence and patterns of cutaneous lesions in 109 pediatric patients with leukemia. Non-specific lesions, namely, adverse reactions to chemotherapy, complications of immunosuppression, and hemorrhagic diathesis were seen in 88.7% of those patients with acute lymphocytic leukemia and in 88.9% of patients with acute non-lymphocytic leukemia. Leukemia cutis was seen in three patients with acute non-lymphocytic leukemia, and in one patient with congenital leukemia. It seems that although skin complications are a frequent event in the course of childhood leukemia, leukemic infiltration of the skin a is rare event.

Epidemiological study of tinea capitis in Puerto Rico.

Two separate studies were carried out to determine the dermatophytes responsible for tinea capitis in Puerto Rico. A retrospective study to determine those agents during the period between 1979 and 1989 revealed a total of 36 mycologically positive cases. The causative organisms consisted of the following species: M. canis, 14 cases (38.9%); T. mentagrophytes, 7 cases (19.4%); T. rubrum, 7 cases (19.4%); M. gypseum, 5 cases (13.9%); and T. tonsurans, T. verrucosum, unclassified Microsporum species, 1 case each (2.8% each). In a prospective study, fungal cultures were obtained from the scalps of 95 randomly selected children (45 males, 50 females) seen at the outpatient dermatology clinics of the Medical Sciences Campus of the University of Puerto Rico for a variety of skin problems but with no symptoms or signs of disease. One culture was positive for M. canis. All other cultures were negative. The significance of these findings is discussed as well as their relation to the incidence of T. tonsurans scalp infections in the Unites States.

Response to treatment and recurrence of dermatomycosis in patients with diabetes.

Thirteen diabetic and sixteen control patients with skin infections with dermatophytes and Candida albicans were evaluated for the response to treatment and the recurrence of the condition. Culture-proven infections of these organisms were treated with a topical antifungal cream (oxiconazole nitrate) for 30 days. There was no difference in response to treatment between the two groups. Nine diabetic and ten control patients were re-evaluated three months after finishing the treatment. Four of the nine diabetic patients (44%) and one of the ten control patients (10% had evidence of recurrence. Dermatophytic skin infections in diabetic patients seem to respond adequately to topical treatment, however, recurrences appear to be frequent.

Cutaneous alterations in patients with chronic renal failure.

The purpose of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF) undergoing hemodialysis or peritoneal dialysis. One-hundred and two patients with CRF were examined for the presence of cutaneous alterations. All patients examined had at least one cutaneous lesion. The most prevalent findings were alterations in the cutaneous pigmentation. Of particular interest was an increased prevalence of hyperpigmented macules on the palms and soles. Other manifestations, seen particularly in the hemodialysis group, included the half-and-half nail, pruritus, and keratotic pits of the palms and soles. Infectious processes were more prevalent in the group undergoing peritoneal dialysis. This study showed that all patients with CRF have some type of cutaneous alteration and that the type of dialysis could have some influence upon the incidence of these changes.

Exogenous ochronosis.

Exogenous ochronosis is a condition characterized by hyperpigmentation of the face secondary to the use of hydroquinone-containing bleaching creams. Histopathologically, it presents a collection of yellowish-brown (ochronotic) globules in the papillary dermis. Two cases of exogenous ochronosis are reported, followed by a review of the literature.

Prevalence of dermatophytosis in patients with diabetes.

BACKGROUND: Controversy still exists as to whether dermatophytic skin infection is truly more common in patients with diabetes. OBJECTIVE: The purpose of this study was to determine the true prevalence of dermatophytosis in diabetic patients as compared with a control population. METHODS: One hundred consecutive diabetic patients were examined for evidence of fungal disease of the skin and compared with nondiabetic, nonimmunocompromised patients. Potassium hydroxide preparation and fungal cultures were obtained from all suspect lesions. RESULTS: Thirty-one percent of the diabetic population had culture-proven fungal infections compared with 33% of the control group. The organism most commonly isolated was Trichophyton rubrum in both groups, and the feet were the most common site of infection. Candida albicans was more prevalent in the control group, affecting the nails in particular (24% vs 15% in the diabetic patients). CONCLUSION: This study shows that there does not seem to be an increased prevalence of dermatophytosis in diabetic patients as compared with a control, nondiabetic patient.

Efficacy of 1, alpha 25-dihidroxyvitamin D (Calcitriol) in the treatment of psoriasis vulgaris: an open study.

Several reports have appeared in the literature suggesting that Vitamin D metabolites and analogues may be useful for the treatment of psoriasis. This is a report of an open study in which the efficacy of 1, Alpha-25-dihydroxyvitamin D (Calcitriol) is evaluated in cases of moderate to severe psoriasis. Study of ten cases showed moderate improvement in four when using calcitriol at a daily dose of 0.5 microgram for a period of three months. All Vitamin D metabolites were within normal limits during and after the trial. Further trials with calcitriol as an adjuvant therapy to topical steroids or photochemotherapy, as well as the development of topical Vitamin D analogues may be the future of this novel therapeutic alternative for psoriasis.

Clinicopathologic study on pityriasis alba.

Pityriasis alba (PA) is a relatively common skin disorder usually seen in children and young adults characterized by the presence of superficial hypopigmented macules. A clinicopathologic study on pityriasis alba was undertaken which showed an increased occurrence of the disease in preadolescent children with an equal incidence in boys and girls, and a predominance of white over black patients. There was an increased personal history of atopy and the skin lesions were found to occur most frequently in the arms and face followed by the legs and the trunk. Histologic evaluation of biopsy specimens of PA showed consistent spongiosis, follicular spongiosis, focal parakeratosis and acanthosis in the epidermis together with a superficial perivascular lymphocytic infiltrate.

Calcifying panniculitis associated with polycystic kidney disease and chronic renal failure.

Tender erythematous nodules and plaques developed on the abdomen and legs of two women, 45 and 48 years of age, with hyperparathyroidism as a result of chronic renal failure caused by polycystic kidney disease. The histopathologic findings of these lesions were characterized by a calcifying panniculitis. Laboratory tests disclosed normal calcium levels and hyperphosphatemia with an elevated level of calcium phosphate product. Calciphylaxis appeared to be the mechanism of soft tissue calcification in these patients.