Dermatology Case Challenge: Colorful Skin Patches on a Man With Fatigue Who Smokes Cigars

Malgorzata K. Nowakowska, BS; Saira George, MD

Disclosures

November 22, 2022

Discussion

Widespread large yellow-orange patches and plaques on the torso, shoulders, and upper arms, accompanied by the histologic finding of lipid-laden macrophages, or "foam cells," are a characteristic presentation of diffuse normolipemic plane xanthomas. Carotenemia presents with a generalized yellow skin discoloration due to excess levels of beta-carotene, most commonly from excessive dietary intake of beta-carotene–rich vegetables. Lipoid proteinosis is a rare autosomal recessive genodermatosis that presents during the first year of life with mucocutaneous and visceral findings related to the deposition of amorphous hyaline material. Necrobiotic xanthogranuloma is a multisystemic histiocytic condition in which yellow-orange papules or plaques most commonly involve the periorbital skin. The protean manifestations of cutaneous sarcoidosis can include yellow-orange papules or plaques, but histologic examination of these lesions typically reveals the noncaseating granulomas typical of the disorder.

Cutaneous xanthomas represent lipid deposition in the skin.[1] The word xanthoma is derived from the Greek word xanthos, meaning yellow, and refers to the distinctive hue of most lesions. Scavenging macrophages that phagocytose and oxidize lipids give rise to the characteristic histologic finding of xanthomas: lipid-laden macrophages, or "foam cells," in the dermis.[2] Additional inflammatory cells, extracellular lipids, and fibrosis may also be present, to varying degrees. The exact mechanisms that lead to lipid deposition in the skin and the formation of xanthomas are not yet fully known but are thought to differ among the various subtypes of xanthomas.[3]

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