Palmar Striated Xanthomas in Clinical Practice

Nathalie Roy; Daniel Gaudet; Diane Brisson

doi:10.1210/jendso/bvac103

Palmar Striated Xanthomas in Clinical Practice

J Endocr Soc. 2022 Jul 2;6(8):bvac103. doi: 10.1210/jendso/bvac103. eCollection 2022 Aug 1.

Authors

Nathalie Roy¹, Daniel Gaudet¹, Diane Brisson¹

Affiliation

¹ Lipidology Unit, Community Genomic Medicine Center, Department of Medicine, Université de Montréal and ECOGENE-21 Clinical and Translational Research Center, G7H 7K9, Chicoutimi, Quebec, Canada.

Abstract

Context: Palmar striated xanthomas (PSX) are macular subcutaneous lesions conferring a yellow-to-orange coloration of palmar and finger creases that characterize dysbetalipoproteinemia, a disease associated with sustained plasma accumulation of triglyceride-rich lipoprotein remnants. Although remnants accumulation may occur in any condition interfering with triglyceride-rich lipoprotein hydrolysis or clearance, the presence of PSX has not been systematically assessed across the spectrum of lipid disorders potentially associated with sustained or recurrent remnants accumulation.

Objective: The aim of this study was to assess the occurrence of (PSX) in a wide spectrum of lipid disorders ranging from very severe hypercholesterolemia (homozygous familial hypercholesterolemia) to very severe hypertriglyceridemia (chylomicronemia).

Methods: This study involved 3382 dyslipidemic White adult patients (1856 men and 1526 women) seen at the Chicoutimi Hospital Lipid Clinic (Quebec, Canada), covering a wide range of lipid disorders, from severe hypertriglyceridemia to severe hypercholesterolemia. Categorical variables were compared using the Pearson χ ² statistic, whereas univariate analysis of variance or nonparametric Kruskal-Wallis was used for continuous variables.

Results: A total of 5.1% (173/3382) of the studied patients presented PSX, a majority of them (67.1%) being women. PSX were observed in 18.8% of patients with dysbetalipoproteinemia and also among 14.1% of hypertriglyceridemic patients with partial lipoprotein lipase deficiency, 3.7% of patients with chylomicronemia, and in all those with homozygous familial hypercholesterolemia. Overall, 10.7% of patients with PSX did not meet dysbetalipoproteinemia diagnosis criteria.

Conclusion: According to our study, the PSX prevalence estimate among patients without dysbetalipoproteinemia would be around 10% and they could be observed in a wide spectrum of lipid disorders associated with recurrent or sustained remnant lipoprotein accumulation.

Keywords: apolipoprotein E; dysbetalipoproteinemia; dyslipidemia diagnosis; palmar striated xanthomas; remnant lipoproteins.