What Are Xanthomas and How Do They Tie in to High Cholesterol?

Xanthomas May Result From Very High Cholesterol Levels

The most common location for a xanthoma is around the inner or outer areas of the eyelids, where they tend to occur in clusters; this particular type of xanthoma is called a "xanthelasma." Xanthomas are also often seen around joints (especially on the elbows or knees), in the creases of the palms and fingers, on the feet and on the buttocks. Tendinous xanthomas are usually located within tendons that travel along the backs of the hands and arms, the tops of the feet or within the Achilles tendon on the heel. Xanthomas may be tiny little bumps, but they also can grow to be as big as three inches in diameter.

Xanthomas occur when you have very high levels of fats (lipids) in your bloodstream, especially low-density lipoprotein cholesterol (LDL-C). LDL levels are often elevated in people who eat a high-fat, low-fiber diet; are overweight; and do not get sufficient exercise. Other factors that may increase LDL-C include:

• Diabetes
• Inherited familial hypercholesterolemia (a genetic condition which causes high cholesterol beginning in childhood)
• Low thyroid levels (hypothyroidism)
• Kidney problems
• Liver problems
• Pregnancy
• Medications, including some antiseizure drugs, diuretics, steroids, cyclosporine and retinoid drugs

Your doctor may diagnose a xanthoma simply by noticing its characteristic appearance. If there is any question, a sample of the growth (biopsy) can be sent to a laboratory for closer examination. If it is a xanthoma, the results of the biopsy will show that the growth is composed of lipids (fats).

Xanthomas can be removed in several different ways. They can be destroyed with acetic acid, via electrical current (electrodessication), by laser treatment or by cutting them out surgically. They may, however, eventually grow back, and it is also possible that additional xanthomas will crop up in other locations. Cosmetic concerns may convince you to have a xanthoma removed, but even more important than its removal, is your attention to the high blood cholesterol that caused it in the first place. Your doctor will want to do a complete lipid panel to track your blood cholesterol and triglyceride levels.

A lipid panel or profile is a set of blood tests that measures blood levels of triglycerides as well as the major forms of cholesterol (total cholesterol, high density lipoprotein cholesterol or HDL and low density lipoprotein cholesterol or LDL). You will usually be asked to fast (consume nothing but water) for 12 to 14 hours before you have your blood drawn for a lipid panel. Generally speaking, you should aim for a total cholesterol of more than 200 mg/dL, for LDL cholesterol less than 129 mg/dL, for HDL cholesterol more than 40 mg/dL for men or 50 mg/dL for women and for triglycerides less than 150 mg/dL.

If you are found to have high cholesterol, you should follow the usual lifestyle recommendations to lower your lipid levels:

• Follow all treatment recommendations if you have diabetes, high cholesterol and/or high blood pressure.
• Reach and maintain a healthy weight.
• Decrease your daily intake of sugary and refined foods; eat more complex carbohydrates and fiber (fruits, vegetables, whole grain products, legumes).
• Decrease your cholesterol intake (less than 300 mg/day for most people or lower than 200 mg/day if you already are known to have heart disease).
• Pay attention to the fats in your diet.
• Don't eat products that contain trans-fats.
• Cut back on saturated fat.
• Eat your fat in the form of healthier monounstaturated fats, such as olive oil or canola oil, and omega-3 fatty acids.
• Exercise regularly, preferably 30 minutes daily.

Depending on your cholesterol level, and depending on how it responds to lifestyle changes, you may also require cholesterol-lowering medications, such as statins, bile acid sequestrants, nicotinic acid, fibrates or drugs that inhibit cholesterol absorption. Dropping your blood cholesterol level may make some xanthomas grow smaller or disappear altogether.

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