Xanthomas

A 59-year-old woman presented for a routine physical examination. She had no physical complaints and took no medications. During the physical examination, bilateral, flat, slightly elevated, yellowish cutaneous lesions were noted above and below the skin folds of the patient's eyelids (A). Soft cutaneous and subcutaneous nodules were found on the knees (B). The patient's total cholesterol level was 346 mg/dL; the triglyceride level was 386 mg/dL. Dr Gopi Rana-Mukkavilli of New York City diagnosed the eyelid lesions as xanthelasmas, or planar xanthomas, yellowish plaques or macules that are associated with hypertriglyceridemia and hypercholesterolemia. The nodules on the patient's knees-tuberous xanthomas- are also related to these hyperlipoproteinemias. Tuberous xanthomas contain lipid-laden histiocytes, or foam cells. They occur most often on extensor surfaces and on areas that are most prone to trauma, such as the elbows and knees. The overlying epidermis may be normal in color or take on a yellowish hue. As the patient's plasma lipid level rises, these lesions arise with increasing frequency; conversely, as high lipid levels decrease and return to normal, tuberous and planar xanthomas gradually recede and may disappear. Simvastatin (20 mg once daily) was prescribed for this patient, and an appropriate diet and exercise regimen were recommended.