What are the other Names for this Condition? (Also known as/Synonyms)

• Palmar Crease Xanthoma
• Palmar Striated Xanthoma
• Xanthoma Striata Palmaris (XSP)

What is Palmar Xanthoma? (Definition/Background Information)

• Palmar Xanthoma, or Palmar Crease Xanthoma, is the formation of yellowish lesions on the crease of palms, typically due to the metabolic condition familial dysbetalipoproteinemia, type III
• Familial dysbetalipoproteinemia (FD) is a hereditary disorder characterized by high amounts of lipids (fat) in the body and blood. In this disorder, there is defective breakdown or metabolism of lipids
• In Palmar Xanthoma, the lipids get deposited in the skin, underneath the skin (subcutaneous), and in the tendons. These are seen as multiple, soft yellow lipid-filled lumps on skin (xanthomas) or tendons
• Palmar Xanthoma is generally observed in young, middle-aged, and older adults. The lesions are usually painless, but numerous in the body. They can be present anywhere in the body; although, Palmar Xanthoma are only described in the folds of the palms
• In a majority of cases, treatment of the underlying lipid condition through diet control, exercises, and prescription medications, is undertaken. The xanthomas may be treated through laser therapy or surgery, if required
• The prognosis for Palmar Xanthoma is good with suitable treatment of the underlying condition causing the skin lesions. However, there is a chance of recurrence following treatment, if lipid levels again increase abnormally

Who gets Palmar Xanthoma? (Age and Sex Distribution)

• Palmar Xanthoma is an uncommon condition that is usually observed in adults
• Even though familial dysbetalipoproteinemia is a congenital disorder, the symptoms often appear after age 20 years in males and post-menopause in females
• Both males and females are affected
• Individuals of all racial and ethnic background may be affected. Worldwide, no geographical localization has been reported

What are the Risk Factors for Palmar Xanthoma? (Predisposing Factors)

• Individuals with type III familial dysbetalipoproteinemia are at risk for developing Palmar Xanthoma
• Family history of the condition may be a risk factor

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Palmar Xanthoma? (Etiology)

The cause of development of Palmar Xanthoma is due to familial dysbetalipoproteinemia (FD). It may be described as the skin manifestation of FD.

• Familial dysbetalipoproteinemia is a metabolic disorder that causes abnormal lipid levels in blood, when metabolism of fat (lipids) is affected
• Lipids in blood combine with certain proteins to form water-insoluble lipoproteins, which accumulate beneath the skin to form xanthomas

What are the Signs and Symptoms of Palmar Xanthoma?

The signs and symptoms of Palmar Xanthoma may include:

• Presence of small yellow papules on the palms, at the crease
• A papule is an area of abnormal skin tissue that is less than 1 cm around. Usually a papule has distinct borders, and it can appear in a variety of shapes
• Lesions may form at the finger folds too
• The lesions are painless and benign

Additional signs and symptoms of the underlying familial dysbetalipoproteinemia may be noted.

How is Palmar Xanthoma Diagnosed?

A diagnosis of Palmar Xanthoma may involve the following tests and exams:

• A thorough medical history and physical examination
• Liver function test
• Lipid profile test
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: A biopsy may be performed to rule out other skin conditions with similar signs and symptoms.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Palmar Xanthoma?

The complications of Palmar Xanthoma may include:

• The presence of multiple lesions may result in cosmetic concerns and emotional stress
• Performing simple daily tasks may be affected
• Scratching the lesions may lead to bleeding and ulceration, which may result in secondary infections
• Formation of new lesions at other body sites, or recurrence of xanthomas after treatment
• Complications that arise from the underlying metabolic disorder

How is Palmar Xanthoma Treated?

The primary treatment of Palmar Xanthoma involves treating the underlying metabolic disorder. The treatment measures may involve:

• Undertaking treatment for familial dysbetalipoproteinemia condition causing Palmar Xanthoma through:
  • Appropriate diet and exercising
  • Weight control, for obese or overweight individuals; maintaining a healthy weight
  • Prescription oral or intravenously-administered medications
  • Undergo follow-up tests and checkups to ensure that lipid levels are controlled
  • Avoiding or minimizing alcohol intake; quitting smoking
• Treatment of skin lesions may involve (if necessary):
  • Application of  trichloroacetic acid (TCA)
  • Laser therapy
  • Surgical excision and removal, if necessary

How can Palmar Xanthoma be Prevented?

Currently, there are no known methods available to prevent the occurrence of Palmar Xanthoma.

• If there is a family history of familial dysbetalipoproteinemia, then genetic counseling will help assess risks, before planning for a child
• Active research is currently being performed to explore the possibilities for treatment and prevention of inherited and acquired genetic disorders
• Having a low-fat diet and adequate physical activities/exercises to maintain optimal weight are beneficial in controlling blood lipid/cholesterol levels

Regular tests and periodic checkups to monitor the condition are recommended following treatment.

What is the Prognosis of Palmar Xanthoma? (Outcomes/Resolutions)

• The prognosis of Palmar Xanthoma is good with appropriate treatment
• In many individuals, the lesions disappear with adequate management of the underlying familial dysbetalipoproteinemia 

Additional and Relevant Useful Information for Palmar Xanthoma:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse