By Gary M. White, MD
Plane xanthomas (PX) are diffuse, planar, yellow discolorations of the skin caused by deposition of xanthomatous cells.
PX may be subdivided into 3 groups by their associations with:
- Other xanthomas and part of a familial hyperlipidemia or secondary to liver disease, usually biliary cirrhosis.
- A paraprotein and elevated lipids.
- A paraprotein but no elevated lipids.
In the later 2, the paraprotein seems to interfere with lipid metabolism and may cause lipoprotein-paraprotein complexes with either elevation of the lipids, or increase in their phagocytosis by macrophages.
- In one case, the paraprotein seemed to display anti-smooth muscle antibody activity [BJD 1995;133;961].
- In another patient, diffuse normolipemic plane xanthomas coexisted with primary systemic amyloid [BJD 1996;135;460].
- PX predate a myeloproliferative disease, e.g., multiple myeloma, leukemia.
Large yellow patches or very slightly elevated plaques are characteristic. In one patient, normolipemic plane xanthomas occurred in a perifollicular distribution [Dermatology 1999;199;97].
Lab tests should include lipid profile, SPEP and other tests to exclude multiple myeloma. Plane xanthomas can precede the appearance of an underlying disease by several years, so careful followup and periodic laboratory examinations are recommended even for patients that seem to have no associated disorder. One report successfully treated PX of the face with 1,444-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser [Ann Dermatol. 2015 Dec; 27(6): 769–770].
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