Clinical manifestation

Xanthelasma palpebrarum variant: asymptomatic, symmetrical, soft, velvety, yellow, flat-topped, polygonal papules on and around eyelids, most commonly in upper eyelid near the inner canthus; may have no associated lipid abnormality or may be associated with hyperlipidemia, where any type of primary hyperlipoproteinemia can be present; occasional association with secondary hyperlipoproteinemias, such as cholestasis

Tuberous xanthoma variant: asymptomatic, firm, red-yellow papules or nodules usually developing in pressure areas, such as knees, elbows, or buttocks; may coalesce to form multilobated tumors; associated with hypercholesterolemia and increased levels of LDL, with familial dysbetalipopro-teinemia and familial hypercholesterolemia or with secondary hyperlipidemias (e.g., nephrotic syndrome, hypothyroidism) Tendinous xanthoma variant: slowly enlarging subcutaneous nodules around tendons or ligaments, often over extensor tendons of the hands, the feet, and the Achilles tendons; sometimes occurs after trauma; associated with severe hypercholesterolemia and elevated LDL levels, particularly in the type IIa form, or secondary hyperlipi-demias such as cholestasis Eruptive xanthoma variant: sudden onset of crops of small, pruritic, red-yellow papules on an erythematous base, most commonly over buttocks, shoulders, and extensor surfaces of extremities; may spontaneously resolve over weeks; associated with hyper-triglyceridemia, particularly with types I, IV, and V (high concentrations of VLDL and chylomicrons) or with secondary hyperlipi-demias, particularly in diabetes Plane xanthoma variant: flat, yellowish papules, occurring in any site, and sometimes covering large areas of face, neck, thorax, and flexures; when palmar creases involved, type III dysbetalipoproteinemia likely diagnosis; may occur with secondary hyperlipidemias, especially in cholestasis, with monoclonal gammopathy and hyperli-pidemia, particularly hypertriglyceridemia Xanthoma disseminatum variant: occurs in normolipemic patients; begins in adults as red-yellow papules and nodules with a predilection for flexures; sometimes also occurs on mucosa of the upper part of the aerodigestive tract; usually resolves spontaneously

Verruciform xanthoma variant: normoli-pemic patients with predominantly oral cavity, solitary, papillomatous yellow nodule or plaque

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