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

The management of xanthomas is generally directed toward treatment of an underlying disease if present. Although xanthomas associated with hyperlipidemia often improve with correction of the lipid disorder, diffuse normolipemic xanthomas may persist even with the treatment of an underlying condition. A number of surgical and destructive treatments for xanthomas, ranging from simple excision to laser ablation, have been tried and may be feasible, depending on the distribution, size, and number of the lesions.[17]

After multiple myeloma was detected in the patient in this case, chemotherapy was scheduled. Because normolipemic plane xanthomas were observed before other manifestations of his disease, the multiple myeloma was detected early, and his prognosis is good. The appearance of the xanthomas improved with treatment of the underlying disease.

In summary, although xanthomas are often associated with lipid disorders, diffuse normolipemic plane xanthoma is a rare variant that most commonly develops in patients with hematologic disorders. A diagnosis of normolipemic plane xanthomas should prompt assessment and ongoing monitoring for an underlying hematologic or lymphoproliferative disease.

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