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 Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 1  |  Issue : 1  |  Page : 59-60

Palmar xanthomas


Department of Dermatology, Christian Medical College, Ludhiana, Punjab, India

Date of Web Publication11-Feb-2014

Correspondence Address:
Anisha George
Department of Dermatology, Christian Medical College, Ludhiana - 141 008, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2348-3334.126801

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  Abstract 

A middle-aged woman presented with a history of asymptomatic lesions over the palms, which were progressively increasing in number. Examination revealed 2-mm sized yellowish papules over the palmar surface of fingers. A clinical diagnosis of palmar xanthomas was made. Fasting lipids indicated elevations consistent with dysbetalipidemia, confirming the diagnosis. We recommend that the thyroid stimulating hormone level and serum electrophoresis should be done as part of the work-up for this rare condition.

Keywords: Dysbetalipidemia, palmar, xanthomas


How to cite this article:
George A, Kanish B, Bhatia A. Palmar xanthomas. CHRISMED J Health Res 2014;1:59-60

How to cite this URL:
George A, Kanish B, Bhatia A. Palmar xanthomas. CHRISMED J Health Res [serial online] 2014 [cited 2020 Sep 18];1:59-60. Available from: http://www.cjhr.org/text.asp?2014/1/1/59/126801


  Case Report Top


A middle-aged lady presented with a history of asymptomatic lesions over the palms, which were progressively increasing in number. Examination revealed 2-mm sized yellowish papules over the palmar surface of her fingers [Figure 1] and [Figure 2]. A clinical diagnosis of palmar xanthomas was made, and a fasting lipid profile was sent. Her triglycerides were 1038 mg/dL, total cholesterol 487 mg/dL, LDL 279 mg/dL and HDL 42 mg/dL, consistent with dysbetalipidemia.
Figure 1: Faintly visible 2-mm sized yellowish papules almost symmetrically
distributed over the palmar aspect of the fi ngers


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Figure 2: Close-up view of the papules with a yellow hue

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  Discussion Top


Lipid deposits in the skin are known as xanthomas. [1] Palmar xanthomas are rare, and seen in around 20% of patients with type III hyperlipidemia, a highly atherogenic disorder, that responds well to therapy, and is also known as remnant particle disease, dysbetalipoproteinemia or broad-beta disease. [2] In this type, chylomicron remnants are increased. Premature vascular disease and recurrent pancreatitis as a result of the increased triglycerides can occur if not treated. [3] Typical expression of the dominantly heritable phenotype is homozygosity at the apolipoprotein E2 (apoE2) gene locus for the apoE2 allele. Heterozygosity was found to be associated with myeloma. [4] Another reportedly associated condition is hypothyroidism. [5]


  Conclusion Top


Palmar xanthomas are rare, seen in the context of dysbetalipidemia, leading to atherogenesis. We recommend that the thyroid stimulating hormone level and serum electrophoresis should be done as part of the work-up for this rare condition.

 
  References Top

1.Lugo-Somolinos A, Sánchez JE. Xanthomas: A marker for hyperlipidemias. Bol Asoc Med PR 2003;95:12-6.  Back to cited text no. 1
    
2.Blom DJ, Byrnes P, Jones S, Marais AD. Dysbetalipoproteinaemia-clinical and pathophysiological features. S Afr Med J 2002;92:892-7.  Back to cited text no. 2
[PUBMED]    
3.Fung M, Hill J, Cook D, Frohlich J. Case series of type III hyperlipoproteinemia in children. BMJ Case Rep 2011;2011.  Back to cited text no. 3
    
4.Burnside NJ, Alberta L, Robinson-Bostom L, Bostom A. Type III hyperlipoproteinemia with xanthomas and multiple myeloma. J Am Acad Dermatol 2005;53:S281-4.  Back to cited text no. 4
[PUBMED]    
5.Retnakaran R, Connelly PW, Goguen J. Unmasking of type III hyperlipoproteinemia by hypothyroidism: A dramatic illustration of altered lipoprotein metabolism in a postpartum woman. Endocr Pract 2005;11:394-8.  Back to cited text no. 5
[PUBMED]    


    Figures

  [Figure 1], [Figure 2]



 

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