Xanthoma

A xanthoma is a small skin bump that appears because fats build up under your skin. Xanthomas may develop anywhere on your body, and they usually appear in groups. But they most commonly appear around your:

• Shoulders
• Elbows
• Hands
• Feet
• Buttocks
• Joints
• Achilles tendons

Xanthomas (pronounced “zan-THOH-muhs”) are harmless and don’t cause pain. But they may associate with other, possibly dangerous conditions that can cause an increase in fats in your body, like high cholesterol (hyperlipidemia) and diabetes.

Treating the underlying condition may cause xanthomas to go away. Your healthcare provider can also remove them.

Other names for xanthomas include:

• Xanthomatous lesion
• Cutaneous xanthomas
• Xanthomatosis

Types

Providers may use different names to help describe where xanthomas appear on your body. These include:

• Xanthelasma: These form on your eyelids.
• Planar xanthomas: These may form anywhere, but they’re more common in the webbing between your fingers and toes.
• Palmar xanthomas: These form on the palms of your hands and wrists.
• Tuberous xanthomas: These form on your elbows, knees or heels.
• Tendon xanthomas: These form near tendons on your body, like your Achilles tendon or around your knuckles.
• Eruptive xanthoma: These can form over your shoulders, buttocks and inside your mouth.
• Verruciform xanthoma: These most commonly affect your mouth. They may also appear on your genitals.

Xanthoma symptoms

Xanthomas may:

• Appear individually or in groups or clusters
• Be discolored (red, pink, orange, purple, yellow or like the surrounding skin)
• Feel firm
• Look waxy or shiny
• Vary in size, from very tiny to over 3 inches (7.5 centimeters) — about the size of a gumball
• Itch

Causes

The main cause of xanthomas is high LDL cholesterol levels. When your LDL cholesterol levels are high, plaque can build up in your arteries and tissues. As it continues to build, you can eventually see it under your skin.

Xanthomas may also develop due to underlying health conditions that cause high levels of fats in your blood (blood lipids). These conditions may include:

• Unmanaged diabetes
• Inborn errors of metabolism (IEM), like familial hypercholesterolemia
• Inflammation of your liver bile ducts
• Inflammation of your pancreas
• Underactive thyroid
• Some types of cancers

It’s also possible for xanthomas to appear without any underlying health issues.

Risk factors

You may be at a greater risk of xanthomas if you:

• Are over 65
• Have high levels of fat in your blood
• Have an underlying condition that needs treatment

Complications

Xanthomas themselves don’t have any complications. But if you don’t treat the underlying conditions, you can increase your risk of serious complications, like:

• Heart disease
• Stroke
• Vascular disease
• Chronic kidney disease (CKD)

How doctors diagnose xanthomas

Providers will first review your health history and ask questions about any symptoms. They can usually diagnose a xanthoma with a physical exam. But they may recommend tests, including:

• Skin biopsy to confirm the bump isn’t skin cancer
• Blood tests to measure your LDL cholesterol levels

How are xanthomas treated?

Treating the cause can reduce the appearance of xanthomas. In some cases, they may even disappear over time. Treatment can also help prevent complications. Your healthcare provider may recommend:

• Adjusting your eating patterns, including cutting back on saturated and trans fats and eating more fruits, veggies and whole grains
• Getting at least 150 minutes of physical activity each week
• Cutting back on alcohol
• Quitting smoking
• Taking medications like statins, PCSK9 inhibitors and ezetimibe to lower your LDL cholesterol levels
• Getting regular checkups to check your cholesterol levels

If you still have xanthomas after treating the cause, laser therapy can help them go away. But there’s a possibility they may come back.

When should I see my healthcare provider?

It’s a good idea to see a healthcare provider any time you notice changes to your skin. You should also schedule an appointment if you have a xanthoma and there are signs of an infection. These may include pain, swelling or oozing fluid.

What can I expect if I have a xanthoma?

Xanthomas themselves are harmless. But sometimes, the underlying health problem that causes them can be serious. Your outlook depends on successfully managing the cause. You may need lifelong treatment or lifestyle changes. Be sure to schedule regular checkups with your provider so you know your treatment is working.