170 Xanthelasma Instruction Examine this patient’s eyes. Salient features History • Jaundice, generalized pigmentation, itching (primary biliary cirrhosis) • Family history of hyperlipidaemia • History of diabetes, hypertension. • Symptoms of hypothyroidism (p. 516) • History of oral contraceptives. Examination • Xanthelasmata (flat yellow nodules or plaques) seen on eyelids and around both eyes, particularly on the inner canthus (Fig. 170.1) • Look for the following signs: • Corneal arcus • Jaundice, generalized pigmentation, scratch marks (primary biliary cirrhosis) • Tendon xanthomata • Palmar xanthomata. • Tell the examiner that you would like to check the following: • Urine sugar • Blood pressure • Pulse and ankle jerks (hypothyroidism). Fig. 170.1 Xanthelasma. Multiple, soft, yellow plaques involving the eyelid. Remember: Blood lipids can often be normal. Diagnosis This patient has xanthelasmata on the eyelids (lesions) and I would like to test serum lipids to exclude an underlying lipid disorder (aetiology). Advanced-level questions In which conditions are xanthelasmata seen? Those in which there is an increase in serum cholesterol (see Fig. 173.1C–E): • Type IIb hyperlipidaemia: increased cholesterol and triglycerides • Type IIa hyperlipidaemia: increased cholesterol only • Type III hyperlipidaemia: equal increase in cholesterol and triglycerides. Mention a few secondary causes of hyperlipidaemia Diabetes mellitus, hypothyroidism, nephrotic syndrome, cholestatic jaundice, excess alcohol intake, oral contraceptives. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Cauda equina syndrome Dermatomyositis Arteriovenous fistula Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Xanthelasma Full access? Get Clinical Tree
170 Xanthelasma Instruction Examine this patient’s eyes. Salient features History • Jaundice, generalized pigmentation, itching (primary biliary cirrhosis) • Family history of hyperlipidaemia • History of diabetes, hypertension. • Symptoms of hypothyroidism (p. 516) • History of oral contraceptives. Examination • Xanthelasmata (flat yellow nodules or plaques) seen on eyelids and around both eyes, particularly on the inner canthus (Fig. 170.1) • Look for the following signs: • Corneal arcus • Jaundice, generalized pigmentation, scratch marks (primary biliary cirrhosis) • Tendon xanthomata • Palmar xanthomata. • Tell the examiner that you would like to check the following: • Urine sugar • Blood pressure • Pulse and ankle jerks (hypothyroidism). Fig. 170.1 Xanthelasma. Multiple, soft, yellow plaques involving the eyelid. Remember: Blood lipids can often be normal. Diagnosis This patient has xanthelasmata on the eyelids (lesions) and I would like to test serum lipids to exclude an underlying lipid disorder (aetiology). Advanced-level questions In which conditions are xanthelasmata seen? Those in which there is an increase in serum cholesterol (see Fig. 173.1C–E): • Type IIb hyperlipidaemia: increased cholesterol and triglycerides • Type IIa hyperlipidaemia: increased cholesterol only • Type III hyperlipidaemia: equal increase in cholesterol and triglycerides. Mention a few secondary causes of hyperlipidaemia Diabetes mellitus, hypothyroidism, nephrotic syndrome, cholestatic jaundice, excess alcohol intake, oral contraceptives. Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window)Like this:Like Loading... Related Related posts: Permanent cardiac pacemaker/implantable cardioverter-defibrillator Cauda equina syndrome Dermatomyositis Arteriovenous fistula Stay updated, free articles. Join our Telegram channel Join Tags: 250 Cases in Clinical Medicine Dec 4, 2016 | Posted by admin in GENERAL & FAMILY MEDICINE | Comments Off on Xanthelasma Full access? Get Clinical Tree
