(Xanthelasma; Fibroma lipomatodes; Vitiligoidea)
Definition. – Benign new-growths consisting of opaque yellowish plaques or flattened nodules.
Symptoms. – This condition has been described in a number of varieties, based chiefly on the form of the lesion: Xanthoma planum, in which the lesions occur as flat patches or plaques; xanthoma palpebrarum, usually seen on or about the eyelids, especially near the inner canthus of the upper eyelid, and consisting of one or more, pea-sized or larger, round or elongated, smooth, opaque, sharply defined, slightly raised yellowish patches, fancifully likened in appearance to chamois leather; xanthoma multiplex includes the tubercular form (xanthoma tuberculatum) and the rare nodulary type (xanthoma tuberosum) which sometimes attains the size of a hen’s egg; xanthoma diabeticorum is a variety accompanying diabetes or glycosuria and is clinically considered as a separate disease but there is so much doubt as to its proper position in the dermal field that I prefer to speak of it in connection with other forms. It is characterized by pin-head-to pea-sized, conical papules or nodules of an orange-red color. The center of the lesion is yellowish, surrounded by a reddish areola. Itching and burning may be present.
It would seem, however, that a better classification is that of Unna who simply distinguishes xanthoma of the eyelids (described above as xanthoma palpebrarum) and the generalized xanthoma which includes all other varieties. Xanthoma of the eyelids is of slow growth and strictly localized, while the other varieties appear rapidly and are generalized. The latter is more apt to be nodular in form with lesions that are more sensitive than the dull plaques of the eyelids, yet retaining the peculiar opacity common to all types. Generalized xanthoma especially favors the hands, elbows, buttocks, knees and feet but has been observed on other parts of the skin, as well as upon the mucous and serous membranes. In this type the eyelids escape and the eruption takes on a chronic character, lasting for months or years.
Etiology and Pathology. – Xanthoma of the eyelids is not uncommon, is usually found in adults and is much more frequent in females. Generalized xanthoma is rare but is found in both sexes, in children and adults. The generalized form may appear in healthy subjects but is more commonly noted in the course of diabetes. It may also follow or accompany hepatic, gouty, rheumatic, cancerous, uteroovarian conditions, hydatids and rarely other diseases.
The condition is essentially a connective tissue new-growth of benign character with possibly a mild inflammatory origin. The fatty degeneration, which may occur with or after the primary changes, accounts for the yellowish color and opacity of the tumor. Local irritation would seem to be a factor in some of the generalized cases, because the favorite sites such as the hands, elbows, buttocks, knees and feet are the parts most subjective to friction and other traumatisms. Xanthomatous lesions have been found in the heart, large veins and arteries, liver, spleen, oesophagus and trachea.
Diagnosis. – Milia are usually pin-head in size and white in color, and their contents can be easily pressed out by simple puncture. It would seem almost impossible to mistake generalized xanthoma, whose acute development, primary red color, solid and often nodular lesions and frequent occurrence in diabetes, jaundice and other diseases is so marked.
Prognosis and Treatment. – This condition is benign, so life is not endangered but the lesions seldom disappear spontaneously. The nature of the complicating disease, associated with the generalized type, naturally influences the prognosis and determines the therapy. If local treatment is necessary, almost any method of removal is to be preferred before excision. The simplest treatment consists in the application of trichloracetic acid in small quantities, carefully protecting the surrounding skin with wax or vaseline. If this does not thoroughly remove the growth, electrolysis may be employed, using a current of from 1 to 5 milliamperes; the growth being punctured superficially and at several points. A 25 per cent. salicylic acid plaster has been successfully used for the larger patches; 10 per cent. solution of mercuric chlorid in collodion will serve the same purpose. When the location is such as to permit it, solidified carbon dioxid is almost convenient and efficient method of removal, using moderate to deep pressure for 30 to 60 seconds, depending upon the size of the growth and its location. The X-rays, galvanocautery and high- frequency currents may be useful in special instances. The treatment of the diabetic type is necessarily that of glycosuria. Any itching or other subjective sensations, present with the generalized eruption, may be relieved by solutions of carbolic acid or liquor carbonis detergens. Internal medication is often demanded when general symptoms are present, but the local growths are seldom influenced by such means alone.