The clinical spectrum of xanthomatous lesions of the eyelids

Abstract

Yellowish papules, nodules, or plaques, namely "xanthomatous" lesions, may be seen on the eyelids in the course of various disorders. The prototype is "xanthelasma palpebrarum" (XP) that is localized only to the eyelids and may be associated with hyperlipidemia. On the other hand, different types of normolipemic disorders may also cause xanthomatous eyelid lesions. Among these, Langerhans cell histiocytosis, diffuse normolipemic xanthoma, and non-Langerhans cell histiocytoses (papular xanthoma, juvenile xanthogranuloma, xanthoma disseminatum, adult-onset xanthogranuloma, adult-onset asthma and periocular xanthogranuloma, necrobiotic xanthogranuloma, Erdheim-Chester disease, Rosai-Dorfman disease, and reticulohistiocytosis) can be listed. The eyelid findings of this heterogeneous group of disorders are challenging to differentiate from each other due to common clinical aspects that may even sometimes mimic XP. Nodularity, induration, ulceration, diffuse eyelid involvement, and extension from eyelids to the neighboring skin may represent the clinical features of xanthomatous lesions other than XP. It is necessary to obtain a thorough history and exclude XP and then perform detailed dermatological and systemic examination, biopsy for histopathologic confirmation, and appropriate specific imaging screens. As some of the conditions may be associated with other systemic disorders, especially malignancies, the differentiation of xanthomatous eyelid lesions has a critical importance, and clinical signs can be guiding.

A clinicopathological analysis of non-infectious granulomatous dermatoses

“…It may represent as a localized idiopathic cutaneous phenomenon or maybe a sign of systemic hyperlipidemia and thus knowing the lipid profile of the patient is important to exclude systemic disease. 10 A miscellaneous group which may show rarely granulomatous lesion like perforating folliculitis was found in three cases which showed dilated infundibulum filled with keratin along with foreign body granuloma.…”

Necrobiotic xanthogranuloma associated with smoldering multiple myeloma: satisfactory response to cyclophosphamide, dexamethasone, and thalidomide

“…6 Periorbital XGN lesions should be distinguished from other adult orbital xanthogranulomatous diseases, as Edheim-Chester disease, adult orbital xanthogranulomatous disease, and adult-onset asthma associated with periocular xanthogranuloma. 7…”

The Significance of Extracellular Cholesterol Crystals or a Cholesterol Granuloma in Xanthelasma

“…This raises a residual doubt as to whether the eyelid lesions were actually juvenile xanthogranulomas, which have a reputation for an association with neurofibromatosis and leukemia along with other neoplasms [3]. A report of bilateral, multifocal, bulky tumors [40] raises the question of whether another histiocytic disease may have been responsible, such as Rosai-Dorfman sinus histiocytosis, Erdheim-Chester disease, reticulohistiocytomas, or adult-onset asthma with orbital xanthogranulomas [41-44]. …”