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

• Diabetic Xanthoma
• XD (Xanthoma Diabeticorum)

What is Xanthoma Diabeticorum? (Definition/Background Information)

• Xanthoma Diabeticorum (XD) is the formation of lesions/nodules on skin due to uncontrolled and severe diabetes. It is a very rare condition that is generally observed in adults. The abnormal cutaneous lesions are known as xanthomas
• The lesions are usually painless, itchy, and many in numbers. They can be present anywhere in the body; commonly, on the back, shoulders, and chest
• Xanthoma Diabeticorum develops secondary to abnormalities in fat/lipid metabolism, which takes place due to diabetes. The skin lesions are benign, but may present cosmetic issues
• In a majority of cases, treatment of the underlying diabetes through diet control, exercises, and prescription medications is undertaken. The xanthomas may be treated through surgery or laser therapy, if required
• The prognosis for Xanthoma Diabeticorum is good with suitable treatment of the underlying disorder. However, there is a chance of recurrence following treatment, if diabetes is not managed adequately

Who gets Xanthoma Diabeticorum? (Age and Sex Distribution)

• Xanthoma Diabeticorum is a very uncommon condition that is observed in individuals with diabetes. Only around 1 in 1,500-2,000 individuals with diabetes may develop Xanthoma Diabeticorum
• It is mostly seen in younger individuals (adults)
• Both males and females may be affected
• Individuals of all racial and ethnic background may be affected. Worldwide, no geographical localization has been reported

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

• Individuals with longstanding and/or poorly-controlled diabetes are at risk for developing Xanthoma Diabeticorum

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 Xanthoma Diabeticorum? (Etiology)

The cause of development of Xanthoma Diabeticorum is due to diabetes. It may be described as the skin manifestation of severe and uncontrolled diabetes.

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

What are the Signs and Symptoms of Xanthoma Diabeticorum?

The signs and symptoms of Xanthoma Diabeticorum may include:

• Presence of small round to oval shaped papules that are firm to touch
• A papule is an area of abnormal skin tissue that is less than 1 centimeter around. Usually a papule has distinct borders, and it can appear in a variety of shapes
• The size of the papules may be between 3 to 6 mm
• The papules may have red-yellow-orange discoloration, with reddish border
• Some lesions are isolated and spaced far away from each other; while in many cases, they appear to cluster together
• The lesions are usually painless and itchy; some are tender to touch
• The papules may be seen all over the body, but frequently affect the upper torso, buttocks, and limbs
• Lesions on the face and inside the mouth are occasionally noted

Additionally, the signs and symptoms of diabetes may be noted.

How is Xanthoma Diabeticorum Diagnosed?

A diagnosis of Xanthoma Diabeticorum may involve the following:

• A thorough medical history and physical examination
• Evaluation of history of diabetes and tests for diabetes such as:
  • Fasting blood glucose level test
  • Oral glucose tolerance test
  • Hemoglobin A1c test
  • Test for blood cholesterol and triglyceride levels
• 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 Xanthoma Diabeticorum?

Xanthoma Diabeticorum may be described as a complication of uncontrolled and severe diabetes. The following complications may be noted:

• The presence of multiple lesions may result in cosmetic concerns and emotional stress
• Scratching the lesions may lead to bleeding and ulceration, which may result in secondary infections
• This may give rise to scar formation on healing
• Formation of new lesions at other body sites, or recurrence of xanthomas after treatment
• Complications that arise from underlying diabetes

How is Xanthoma Diabeticorum Treated?

The primary treatment of Xanthoma Diabeticorum involves treating the underlying metabolic disorder (diabetes). The treatment measures may involve:

• Undertaking treatment for underlying diabetes, which includes:
  • Appropriate diet and exercising
  • Weight control, for obese or overweight individuals
  • Prescription oral or intravenously-administered medications
  • Subcutaneous insulin injections
  • Prescription oral or intravenously-administered medications
  • Undergo follow-up tests and checkups, to ensure that blood sugar levels are controlled
• Treatment of skin lesions may involve (if necessary):
  • Surgical excision and removal
  • Laser therapy
  • Use of chemical peeling agents, such as trichloroacetic acid (TCA)
  • In a majority of cases, removal of the lesions are not necessary, unless they cause worrisome signs and symptoms such as cosmetic issues

How can Xanthoma Diabeticorum be Prevented?

• Currently, there are no known methods available to prevent the occurrence of Xanthoma Diabeticorum
• However, certain steps may be taken to decrease one’s risk for the condition by controlling diabetes and keeping blood sugar at optimum levels

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

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

• The prognosis of Xanthoma Diabeticorum is good with appropriate treatment of the underlying diabetes
• In many individuals, the lesions are known to spontaneously disappear with adequate management of diabetes

Additional and Relevant Useful Information for Xanthoma Diabeticorum:

• 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