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Indian Journal of Dermatology
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E-IJD QUIZ
Year : 2015  |  Volume : 60  |  Issue : 4  |  Page : 425
Firm skin-colored nodules on the scalp


1 Department of Dermatology, Medical College and Hospital, Kolkata, West Bengal, India
2 Burdwan Medical College, Burdwan, West Bengal, India
3 Plastic Surgery, Medical College and Hospital, Kolkata, India

Date of Web Publication10-Jul-2015

Correspondence Address:
Dr. Anupam Das
"Prerana" 19, Phoolbagan, Kolkata - 700086, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-5154.160554

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How to cite this article:
Das A, Podder I, Chandra S, Mondal AK, Jash P, Gharami RC. Firm skin-colored nodules on the scalp. Indian J Dermatol 2015;60:425

How to cite this URL:
Das A, Podder I, Chandra S, Mondal AK, Jash P, Gharami RC. Firm skin-colored nodules on the scalp. Indian J Dermatol [serial online] 2015 [cited 2021 Jun 16];60:425. Available from: https://www.e-ijd.org/text.asp?2015/60/4/425/160554


A 24-year-old non-obese, non-diabetic, normotensive young man presented with a history of gradually enlarging multiple painless nodules over the scalp for the last 5 years. There was no history suggestive of any systemic disease or long-term intake of any drug. Family history revealed non-consanguinity and absence of similar cutaneous lesions among family members, though his father had an episode of acute myocardial infarction in the past. Family history was significant for the presence of dyslipidemia in his father and two of his elder brothers. Cutaneous examination revealed four, firm, non-tender, mobile, skin-colored nodules, 2-4 cm in size with a bosselated surface present over the right temporal region of the scalp behind the ear [Figure 1]. No other lesions were found in any other part of the body. Hairs, nails and mucosae were within normal limits. Systemic examination including cardiovascular system was normal and ophthalmological examination did not reveal any abnormality. Routine investigations including complete hemogram, blood sugar, liver and kidney function tests and urine analysis were all normal. Lipid profile and thyroid-stimulating hormone (TSH) levels were found to be in the normal range. Chest X-ray, electrocardiogram (ECG) and ultrasonongraphy (USG) of abdomen were normal. Serum protein electrophoresis revealed normal pattern. Human immunodeficiency virus (HIV) and venereal disease research laboratory (VDRL) serology were non-reactive. Histopathological examination from a representative nodular lesion showed collections of foam cells and lipid laden macrophages with areas of fibrosis and cholesterol clefts [Figure 2] and [Figure 3].
Figure 1: Firm skin-colored nodules with the bosselated surface over the right temporal region of the scalp behind the ear

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Figure 2: Photomicrograph showing collections of foam cells along with dense proliferation of fibroblasts and histiocytes (H and E, ¡¿ 100)

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Figure 3: Photomicrograph showing collections of foam cells, lipid laden macrophages, areas of fibrosis, cholesterol clefts, fibroblasts and histiocytes (H and E, ¡¿ 100)

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Question

What is your diagnosis?



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   References Top

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James WD, Elston DM, Berger TG. Andrews′ Diseases of the skin: Clinical Dermatology. 11 th ed. United Kingdom: Saunders Elsevier; 2011. p. 520-2.  Back to cited text no. 1
    
2.
Sarkany RP, Breathnach SM, Morris AA, Weismann K, Flynn PD. Metabolic and nutritional disorders. In Rook′s textbook of dermatology. In: Burns T, Breathnach S, Cox N, Griffiths C. editors. 8 th ed. United Kingdom: Wiley-Blackwell Publisher (P) Ltd; 2010. p. 59.84-6.  Back to cited text no. 2
    
3.
Kim JY, Jung HD, Choe YS, Lee WJ, Lee SJ, Kim DW, et al. A Case of Xanthoma Disseminatum Accentuating over the Eyelids. Ann Dermatol 2010;22:353-7.  Back to cited text no. 3
    
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Aldabagh B, Al-Dabagh A, Usmani AS, Puri PK. Verruciform Xanthoma of the Earlobe in an Immunosuppressed Patient. Cutis 2013;91:198-202  Back to cited text no. 4
    
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Borer M, Smith J, White B, Sheehan D. A scaly plaque on the scalp. Arch Dermatol. 2007;143:1067-72.  Back to cited text no. 5
    
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Singh AP, Sikarwar S, Jatav OP, Saify K. Normolipemic Tuberous Xanthomas. Indian J Dermatol. 2009;54:176-79.  Back to cited text no. 6
    
7.
Fleischmajer R, Tint GS, Bennett HD. Normolipemic tendon and tuberous xanthomas. J Am Acad Dermatol. 1981;5:290-6.  Back to cited text no. 7
    
8.
Parker F. Normocholesterolemic xanthomasis. Arch Dermatol. 1986;122:1253-57.  Back to cited text no. 8
    
9.
Bhagwat PV, Tophakhane RS, Kudligi C, Noronha TM, Thirunavukkarasu A. Familial combined hypercholesterolemia type II b presenting with tuberous xanthoma, tendinous xanthoma and pityriasis rubra pilaris-like lesions. Indian J Dermatol Venereol Leprol. 2010;76:293-6.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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