Eruptive xanthomas as a marker for metabolic disorders: A specific form of xanthoma that reflects hypertriglyceridemia

Figures

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  FIGURE 1. Clinical images of eruptive xanthomas. Multiple red to salmon pink papule clusters. (A) Bilateral thigh, front. (B) Bilateral thigh, back. (C) Left forearm

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  FIGURE 2. Histological findings of a skin biopsy specimen from the left forearm. Pathophysiological examination with hematoxylin‐eosin staining. (A) Appearance of eruptions. An eruption surrounded by four dotted markings was investigated using microscopy. (B) Low magnitude (×40). Massive foam cells (indicated by arrows) infiltrating into the superficial layer of dermis. (C) High magnitude (×400). Eosinophilic substrate (asterisks), probably indicating extracellular lipids, were observed between collagen fibers. Additionally, foam cells are indicated by arrows

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  FIGURE 3. Lipoprotein profiles. Lipoprotein fractions are demonstrated using polyacrylamide gel electrophoresis. (A) Results of lipoprotein fraction in wave expression method. (B) Results of polyacrylamide gel staining. Compared to control subjects

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  FIGURE 4. Ultrasonography. Abdominal ultrasonography revealing a bright liver

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  FIGURE 5. Summary of the pathological relationships between eruptive xanthoma, hypertriglyceridemia, and atherosclerosis. Obesity and diabetes mellitus have potentials to increase serum remnant lipoproteins, namely TG‐rich lipoproteins, and lead to the hypertriglyceridemia. Marked increase in the levels of serum TG‐rich remnant lipoproteins infiltrate into the subcutaneous tissue and would be taken up by migrated macrophages, which turn into lipid‐filled foam cells. The accumulation of these foam cells increases the risks of developing eruptive xanthomas in the subcutaneous tissue or atherosclerosis in the vessels. Abbreviations: ANGPLT3, angiopoietin‐like protein 3; FFA, free fatty acid; IL‐1β, interleukin‐1β; IL‐6, interleukin‐6; LPL, lipoprotein lipase; TG, triglyceride; TNF‐α, tumor necrosing factor‐α; VLDL, very low‐density lipoprotein