There are three basic physical examination findings that will be discussed. These findings are clinical clues to the clinician and indicate that a patient may have elevated lipid levels. These are discussed to demonstrate that elevated serum cholesterol levels can visibly impact the patient.
- Tendinous xanthomas: A xanthoma is a hard nodule under the skin. These nodules are composed of accumulated lipids. Tendinous xanthomas commonly erupt over tendons such as the Achilles tendon and tendons of the fingers. It should be noted that they can erupt over other tendons and ligaments as well. Tendinous xanthomas are skin-colored and associated with elevated levels of LDL cholesterol. Familial hyperlipidemia is a condition with elevated LDL cholesterol that we will review in a future slide.
- Eruptive xanthomas: This term describes a group of yellow or red elevated lesions. These lesions have a tendency to appear on the back of the arms and front of the legs. They can also appear on the buttocks. Eruptive xanthomas are associated with severe hypertriglyceridemia.
- Xanthelasma: This term refers to soft, cholesterol-filled deposits under the skin around the eyelids. They will usually appear around both eyelids and are associated with hypercholesterolemia.
Images of these dermatological findings are presented on the next pages.
