The clinical spectrum of xanthomatous lesions of the eyelids.

Yellowish papules, nodules, or plaques, namely "xanthomatous" lesions, may be seen on the eyelids in the course of various disorders. The prototype is "xanthelasma palpebrarum" (XP) that is localized only to the eyelids and may be associated with hyperlipidemia. On the other hand, different types of normolipemic disorders may also cause xanthomatous eyelid lesions. Among these, Langerhans cell histiocytosis, diffuse normolipemic xanthoma, and non-Langerhans cell histiocytoses (papular xanthoma, juvenile xanthogranuloma, xanthoma disseminatum, adult-onset xanthogranuloma, adult-onset asthma and periocular xanthogranuloma, necrobiotic xanthogranuloma, Erdheim-Chester disease, Rosai-Dorfman disease, and reticulohistiocytosis) can be listed. The eyelid findings of this heterogeneous group of disorders are challenging to differentiate from each other due to common clinical aspects that may even sometimes mimic XP. Nodularity, induration, ulceration, diffuse eyelid involvement, and extension from eyelids to the neighboring skin may represent the clinical features of xanthomatous lesions other than XP. It is necessary to obtain a thorough history and exclude XP and then perform detailed dermatological and systemic examination, biopsy for histopathologic confirmation, and appropriate specific imaging screens. As some of the conditions may be associated with other systemic disorders, especially malignancies, the differentiation of xanthomatous eyelid lesions has a critical importance, and clinical signs can be guiding.

Non-typical morphology and localization in Turkish atopic dermatitis patients with onset before the age of 18 years.

BACKGROUND: Hanifin and Rajka's criteria (HRC) are the gold standard for the diagnosis of atopic dermatitis (AD). Apart from the age-related distribution and typical morphology of the lesions as defined in one of the major criteria of HRC, patients may also show nontypical morphology and localization. AIM: The aim of this study was to find the frequency of nontypical morphology and localization in Turkish AD patients with onset before the age of 18 years, who were diagnosed according to HRC. METHODS: This was a methodological study based on the analysis of patients' data derived from the checklists of HRC and precise clinical documentation of each patient. A total of 321 Turkish patients diagnosed between 1996 and 2004 with the onset of AD before the age of 18 years were allocated to the study group. RESULTS: 49.5% of patients had nontypical localization of AD, the majority being infants or children who had flexural involvement rather than the typical cheek or extremity lesions. Lichenified/exudative eczematous pattern was the most frequent morphologic type (45.5%); however, 54.5% of the patients showed combined or isolated variants, e.g. nummular and seborrheic patterns, in particular. CONCLUSIONS: A considerable amount of Turkish patients with AD before the age of 18 years presented with nontypical morphology and/or localization according to their age group. The confirmation of our findings in a multicentric prospective study would further allow a completion and correction of the diagnostic criteria of AD for age groups.