Internist's view on skin manifestations of hyperlipidemia in diabetic patients
Authors:
Z. Zadák
Authors‘ workplace:
Klinika gerontologická a metabolická Lékařské fakulty UK a FN, Hradec Králové, přednosta prof. MUDr. Luboš Sobotka, CSc.
Published in:
Vnitř Lék 2006; 52(5): 465-469
Category:
Diabetes and other subjects (infection, dermatovenerology and rheumatology) Hradec Králové 3 to 4 June 2005
Overview
Xanthoma and xanthelasma are typical symptoms of lipid and lipoprotein metabolism impairment. On the basis of their incidence and morphology, it is even possible to specify the impairment type. Hypercholesterolemia or certain liver dysfunctions are characterized by slow development of surface xanthelasmas usually located on mechanically stressed regions (e.g. eyelids). Tuberous and tendinous xanthomas are typical for familiar hypercholesterolemia and are common symptoms of homozygous familiar hypercholesterolemia. Small and quickly developing eruptive xanthomas are typical for mixed hyperlipoproteinemia (secondary hyperlipoproteinemia is typical for diabetes). Mechanism of accumulation of lipids in skin morphs is similar to the development of atheroma, especially when talking about the role of modified LDL and the way of accumulation of lipids in macrophages. The following factors are very important for etiopathogenesis of skin xanthomas development: mechanical stress of tissues, increased permeability of skin capillaries and reaction of proteoglycans in sparse connective tissue. Xanthomas and xanthelasmas are typical indicators of other complicating diseases as e.g. development of acute pancreatitis during hyperlipoproteinemic crisis, aggravation of insulin resistance, and decompensation of type 2 diabetes mellitus. The therapy focuses on adjustment of dietary regime (elimination of dietary fat and concentrated saccharides); no food and sufficient hydration via infusion of crystalloid solutions is indicated in cases of serious hyperlipoproteinemic crisis. In vital indication, it is possible to perform repeated plasmapheresis (or better continual plasmapheresis) that can correct even serious hyperlipoproteinemic crises within several hours. And what is more, continual plasmapheresis can significantly reduce the period when hyperlipoproteinemic crisis might induce acute necrotizing pancreatitis. In the long run, we require that patients strictly observe their dietary regime based on the type of hyperlipoproteinemia. As for medicamentous therapy, fibrates and atorvastatin (from statin family) are the preparations of choice. It is very important not to focus on symptoms, i.e. xanthoma or xanthelasma, but fully compensate lipid metabolism impairment or the disease that underlies hyperlipoproteinemia (e.g. type 2 diabetes mellitus or metabolic syndrome). Unfortunately, it still can be seen that dermatologists, ophthalmologists or plastic surgeons remove extensive xanthelasmas, while the underlying cause is not approached diagnostically and therapeutically at all.
Key words:
xanthelasma – hyperlipoproteinemia – continual plasmapheresis – metabolic syndrome – hyperlipoproteinemic crisis
Sources
1. Frankel RM, Capone R. Xanthelasmas and xanthomas - cutaneous clues to systemic lipid disorders. Clinical Eye and Vision Care 1995; 7: 117-128.
2. Ribera M, Pintó X, Argimon JM et al. Lipid Metabolism and Apolipoprotein E Phenotypes in Patients With Xanthelasma. The American Journal of Medicine 1995; 99: 485-490.
3. Bhatnagar D. Hypertriglyceridaemia. In: Betteridge DJ, Illingworth DR, Shepard J. Lipoproteins in health and disease. New York: Oxford University Press 1999.
4. Zadák Z, Tichý M, Mělka O. Vliv chylozity séra na výsledky některých biochemických vyšetření. Biochem Clin Bohemoslov 1987; 16: 251-259.
5. Zadák Z, Tichý M. Hyperlipidemia and monoclonal gammapathy. Neoplasma 1987; 34: 169-172.
6. Zadák Z, Vaňásek J, Bláha M et al. Treatment of hyperlipoproteinaemias using plasma exchange. Hradec Králové: Sborník vědeckých prací LF UK Hradec Králové 1982; 25: 45-73.
Labels
Diabetology Endocrinology Internal medicineArticle was published in
Internal Medicine
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