Xanthelasma
Introduction
Introduction to xanthoma Xanthoma (xanthoma) is a lipid-deposition disease characterized by skin lesions. Cells that phagocytose lipids are localized in the dermis and tendons. Clinically, they appear yellow, orange or brown-red papules, nodules or plaques. Piece. Often accompanied by systemic lipid metabolism disorders and cardiovascular system damage, can be secondary or secondary to other systemic diseases. basic knowledge Sickness ratio: 0.05% Susceptible people: no specific population Mode of infection: non-infectious Complications: multiple myeloma macroglobulinemia lymphoma leukemia
Cause
Cause of xanthoma
Hyperlipoproteinemia (26%):
Hyperlipoproteinemia is the main cause of xanthomas. Excessively elevated cholesterol, triglycerides and phospholipids in patients' plasma lipids are easily deposited in the dermis of the skin surface. They are found in various types of primary and secondary. In the case of hyperlipoproteinemia.
Other diseases (20%):
Patients with normal plasma lipids may also develop xanthomas, which are called normal lipoproteinemia xanthoma. The pathogenesis is due to abnormal lesions of plasma proteins or abnormal proliferation of tissue cells leading to secondary plasma lipid localization. Deposition, as seen in multiple myeloma, hypergammaglobulinemia, macroglobulinemia and lymphoma, leukemia, etc., in some primary histiocytosis and Langerhans histiocytosis (tissue cells) Xanthoma can be seen in patients with hyperplasia X).
Genetic enzyme deficiency (20%):
In addition, due to genetic enzyme deficiency caused by glucocerebroside, sphingomyeopathy and other patients may also have xanthomatous damage.
Prevention
Xanthoma prevention
1, adjust the diet, long-term adherence, maintain balanced nutrition, for overweight patients, should reduce excessive total calories.
2, reduce daily calorie intake, promote scientific diet, regular physical exercise, prevent obesity.
3, quit smoking, alcohol, active treatment of diabetes, hypothyroidism and other diseases.
Complication
Yellow tumor complications Complications, multiple myeloma, macroglobulinemia, lymphoma, leukemia
Multiple myeloma, hypergammaglobulinemia, macroglobulinemia and lymphoma, leukemia, etc., in some primary histiocytosis and Langerhans histiocytosis (histocytosis X) Yellow tumors can be seen in patients, and in addition, glucosinolates due to genetic enzyme deficiency, sphingomyeopathy and other patients may also have xanthomatous damage.
Symptom
Symptoms of xanthoma common symptoms maculopapular blush jaundice ring granulomatous cortical follicle atrophy urinary collapse fat metabolism disorder
Types of
According to the morphology and location of the xanthoma, there are mainly the following types in clinical practice.
(a) flat xanthomas
It is a pale yellow to orange-yellow flat papule or plaque slightly higher than the leather surface. From rice to broad bean size, the boundary is clear. The most common clinically common one is around the eyelid, which is called sputum xanthoma. Women of the year, which occur in the upper eyelids, single or multiple, slow development, can affect the upper and lower eyelids on both sides, forming a yellow circle around the circumference, very special, if this type of yellow tumor appears after 40 years old Lipid abnormalities are often not detected, but in patients with adolescents, hyperlipoproteinemia type II is often present. Flattened xanthoma is occasionally symmetrical in the periorbital, cervical, trunk and limbs. Among patients with various abnormal proteinemias, called generalized normal lipemia flattened xanthomas, flattened xanthomas can appear along the palmprint and palm palm surface texture, called palmetto xanthoma, often With hyperlipoproteinemia type III.
(B) nodular xanthoma
From soybeans to walnuts, even egg-sized papules or nodules, soft at first, yellowish to orange, later solidified by fibrosis, brownish red, slowly increasing and blending can be significantly higher than the leather surface Leaf-like plaques with clear boundaries, which occur in the elbow, knee, knuckle extension, hip, hip and other parts, often accompanied by hyperlipoproteinemia type II, III and IV. Nodular xanthoma can occur in tendon , ligaments and fascia, also known as jaundice, more common in the Achilles tendon, deep nodules, solid, more common in patients with severe hyperlipoproteinemia type II and secondary hyperlipoproteinemia .
(three) rash yellow tumor
For most needles to the big head of the soft small pimples, initially orange, surrounded by red halo, then turned yellow brown, suddenly into a wholesale out of the trunk, hips and limbs, and can involve the lips and oral mucosa, can quickly Self-resolved without leaving traces, patients with hyperlipoproteinemia I, V type, occasionally seen in type III or secondary hyperlipoproteinemia.
(four) disseminated xanthoma
Is a rare normal lipemia non-familial xanthoma, common in young men, multiple rash small papules and nodules, from orange, red-yellow to mahogany, piled up without fusion, often symmetrical Distributed in the neck, ankle, elbow fossa, groin, axillary and torso flexion, about 1/3 of patients have mucosal damage, can affect the mouth, nose, throat and even trachea; about 1/3 of patients can involve the hypothalamus The disease causes diabetes insipidus, and the course is chronic but spontaneously relieved.
Clinical features
a xanthomas occur in middle-aged people, especially women with liver and gallbladder diseases. Other types do not have a certain age and gender.
b May be associated with lipodystrophy caused by endocrine disorders.
c different types of xanthoma have different predilection sites, nodular xanthoma occurs in the elbow and knee; jaundice occurs in the hand, extensor tendon and Achilles tendon; jaundice occurs in the eyelid; rash Yellow tumors occur in the buttocks.
d Skin lesions are yellow or orange-colored maculopapular rash or nodules.
e Common types associated with hyperlipidemia are divided into nodular xanthoma, jaundice, jaundice, rash xanthomas.
Examine
Yellow tumor examination
The examination items should include serum appearance, blood lipid determination and lipoprotein electrophoresis to identify hyperlipoproteinemia and its type. There are fashionable protein electrophoresis, serum protein, immunoglobulin determination, cardiovascular system function test and xanthoma histopathology. an examination.
Lipoprotein electrophoresis normal value: -lipoprotein 0.300.40 -lipoprotein (containing pre--lipoprotein) 0.600.70.
Diagnosis
Diagnosis and identification of xanthomas
diagnosis
According to the characteristics of skin lesions, especially the color and distribution of the damage is easy to diagnose, it is important to determine whether there is a concomitant disease, according to the type of xanthomas, the age of occurrence, the family morbidity and the symptoms and systems of the various systems. The examination, combined with the necessary laboratory results, can further determine whether there are other systemic conditions.
General pathological changes
a The epidermis is generally thin.
b There are many xanthomatic cells in the dermis, foam cells, or aggregated into nodular or diffuse distribution.
The core of the polynuclear xanthoma cells can be gathered near the center of the cell, surrounded by a small piece of non-foaming cytoplasm, and then surrounded by a foamy cytoplasm to become a Touton giant cell.
d Nodular xanthomas, jaundice and jaundice have the same pathological features, and there are most xanthomatic cells and foam cells in the dermis.
e Xanthoma cells initially appear around the blood vessels and later aggregate into bundles or nodules between the collagen.
f Infiltration of sparse lymphocytes around the blood vessels.
g rash xanthomas are small, while lymphocytes, neutrophils and eosinophils are relatively more, and Touton giant cells are less.
h can be seen intracellular and extracellular lipids, forming a type similar to a ring granuloma.
Differential diagnosis
The disease should be differentiated from various X-type histiocytosis and non-X histiocytosis, Langerhans cell hyperplasia, juvenile yellow granuloma, progressive nodular histiocytoma.
