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Xanthelasma
Published in Charles Theisler, Adjuvant Medical Care, 2023
Xanthelasma is a localized deposit of fat and cholesterol near the inner canthus of the eyelid. Xanthelasmas appear as a yellowish, raised plaque, more often on the upper lid than on the lower lid. Some xanthelasmas can be indicative of hyperlipidemia that can be associated with increased risk of coronary heart disease or occasionally with pan-creatitis (due to hypertriglyceridemia). About half the people with xanthelasma have high cholesterol. These patches will not go away on their own and may grow in size. Removal, although not without some unwanted side effects, may be the best option, but the growths can come back.
The Nutrition-Focused History and Physical Examination (NFPE) in Malnutrition
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Next, we examine the eyes closely. Note the presence of xanthelasma that may indicate abnormal lipid metabolism. As noted in the discussion on fat stores, receding orbital fat pads in PCM leave the eyes sunken and surrounded by dark circles. Look at the extraocular eye movements. Ophthalmoplegia (especially abducens palsy) and nystagmus (particularly vertical nystagmus) are signs of Wernicke’s syndrome (see neuro, above). Dry conjunctiva and Bitot’s spots (conjunctival thickening or clumped cells) are a sign of vitamin A deficiency. The fundi may show lipemia retinalis in chylomicronemia and papilledema with pseudotumor cerebri from vitamin A or D toxicity.
Dyslipidemia
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Dyslipidemia is usually asymptomatic. However, it leads to vascular disease that does have symptoms, including coronary artery disease, peripheral artery disease, and stroke. Acute pancreatitis can be caused by high levels of triglycerides (more than 500 mg/dL, equivalent to over 5.65 mmol/L). These high levels also cause confusion, dyspnea, hepatosplenomegaly, and paresthesias. High LDL levels may cause arcus corneae as well as tendinous xanthomas of the Achilles, elbow, and knee tendons, and above the metacarpophalangeal joints (see Figure 8.2). Xanthomas are yellowish in color with surrounding erythematous borders, resulting from increased local extravasation of lipids through the vascular wall to the interstitial spaces of connective tissues. High LDL, as with familial hypercholesterolemia, also causes xanthelasma, which may also develop along with primary biliary cirrhosis even when lipid levels are normal. Xanthelasma usually develops on or around the eyelids in a bilateral and symmetric distribution. The lesions are soft, yellow in color, nontender, and nonpruritic.
Recognizing skin conditions in patients with cirrhosis: a narrative review
Published in Annals of Medicine, 2022
Ying Liu, Yunyu Zhao, Xu Gao, Jiashu Liu, Fanpu Ji, Yao-Chun Hsu, Zhengxiao Li, Mindie H. Nguyen
Xanthelasma (Figure 3(e)) manifests as pale yellow, planar or slightly bulged, soft plaques around the eyelids, being essentially subcutaneous lipid deposits. The condition is associated with dyslipoproteinaemia secondary to liver diseases such as PBC and other forms of cholestatic liver disease. The condition is seen most frequently in females over 50 years old, and half of the cases present with comorbid dyslipidemia. Xanthelasmas associated with the autosomal dominant form of hereditary hypercholesterolaemia develop during childhood and the clinical profile includes xanthelasma, tendon xanthoma, increased low-density lipoprotein, arcus corneae and premature coronary artery disease [68]. One case of regression has been reported after liver transplantation in a patient with PBC [69].
Clinical, laboratory and genetic features of Erdheim-Chester disease patients: analysis of a retrospective cohort of two reference centers in Latin America
Published in Hematology, 2022
Antonio Adolfo Guerra Soares Brandão, André Ramires Neder Abdo, Luís Alberto de Pádua Covas Lage, Giancarlo Fatobene, Juliana Pereira, Vanderson Rocha
In our cohort, the main ECD involved organ was bone (75% – 12/16), followed by skin (43.8% – 7/16), central nervous system (CNS) (43.8% – 7/16), lymph node (25% – 4/16), lung (12.5% – 2/16), liver (6.3% – 1/16), spleen (6.3% – 1/16), muscle (6.3% – 1/16) and gastrointestinal tract (6.3% – 1/16). The majority of CNS lesions occurred in the pituitary gland (86% – 6/7). Twelve patients (75%) presented involvement of more than one organ, characterizing a multi-organic form. Xanthelasma and xanthomas were the most common skin lesions. The most frequent clinical manifestations were bone pain (43.8% – 7/16) and neurogenic diabetes insipidus (37.5% – 6/16). Osteosclerotic lesions occurred in 75% (12/16) of cases, retroperitoneal fibrosis and thickening of the renal fascia (‘hairy kidney’ or ‘perinephric straining’) in 37.5% (6/16), 25% (4/16) presented coated aortic sign, and orbital infiltration was found in 25% (4/16), constituting the highly specific features for the diagnosis of ECD. Table 1 summarizes the main clinical-molecular characteristics, therapeutic modalities and responses of the 16 Brazilian patients with ECD included in our analysis.
Association of tissue inhibitor of metalloproteinase 2 with non-alcoholic fatty liver disease in metabolic syndrome
Published in Archives of Physiology and Biochemistry, 2019
Saira Yasmeen, Unab Khan, Ghulam Mustafa Khan, Syeda Sadia Fatima
Weight and height of subjects were measured in kilograms and metres respectively, using fixed stadiometer (ZT-120 Health scale, made in China). BMI was calculated using the formula weight (kg) divided by height (m2) (kg/m2). WHO Stepwise Approach to Surveillance (STEPS) protocol was used to measure the waist circumference (World Health Organization 2011). The body fat percentage was measured using Diagnostic Scale BG55 by Beurer (Germany) through bioelectrical impedance analysis (BIA). Patients were also examined clinically for the presence of xanthomas (accumulation of lipid foam cells in subcutaneous tissue) or xanthelasma (yellowish fat deposits around/on the eye lid, under the skin). Blood pressure was measured from right upper limb in sitting position using an aneroid sphygmomanometer after the subject was at rest for 5 min.