Dermatology: Practical and Conceptual


Image Letter  |  Dermatol Pract Concept 2021;11(1):e2021134 1

Dermatology Practical & Conceptual

Golden Lady
Andrina Neff1, Alexandra Valeska Matter1, Isabel Kolm1

1 Department of Dermatology, University Hospital of Zurich, Switzerland

Key words: plane xanthoma, monoclonal gammopathy, lymphoproliferative disease, hyperlipidemia

Citation: Neff A, Matter AV, Kolm I. Golden lady. Dermatol Pract Concept. 2021;11(1):e2021134. DOI: https://doi.org/10.5826/
dpc.1101a134

Accepted: August 2, 2020; Published: January 29, 2021

Copyright: ©2021 Neff et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License  
BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original author 
and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author:  Isabel Kolm-Djamei, MD, Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, 8091 
Zurich, Switzerland. Email: Isabel.Kolm-Djamei@usz.ch

Case Presentation

A 93-year-old woman presented with confluent yellow plaques 

with an intense golden glow symmetrically on the neck and 

lateral face (Figure 1, A and B) mimicking a golden camou-

flage. The histopathology showed CD68-positive foamy mac-

rophages in the papillary dermis (Figure 1, C and D), leading 

to the diagnosis of plane xanthoma. Our patient showed mild 

dyslipidemia (total cholesterol 6.4 mmol/l [<5.0 mmol/l]). 

Clinical stigmata for familial  hyperlipidemia were not pres-

Figure 1.  (A, B) Remarkable presentation of plane xanthoma on the neck and lateral face with a golden hue in a 93-year-old woman. (C, D) 

Histopathology of plane xanthoma with CD68-positive foamy macrophages in the papillary dermis.



2  Image Letter  |  Dermatol Pract Concept 2021;11(1):e2021134

precede such disorders by several years; therefore, a regular 

follow-up is recommended. 

References 

1. Cohen YK, Elpern DJ. Diffuse normolipemic plane xanthoma as-

sociated with monoclonal gammopathy. Dermatol Pract Concept. 

2015;5(4):65-67. DOI: 10.5826/dpc.0504a16. PMID:26693095.

2. Morsink LM, Nijhof IS. Diffuse plane normolipaemic xanthomato-

sis as a manifestation of monoclonal gammopathy. Br J Haematol. 

2019187(4):411. DOI: 10.1111/bjh.16141. PMID:31407310.

ent. Due to the distribution pattern, underlying hematological 

disorders were ruled out. 

Teaching Point 

The location of plane xanthomas can serve as a clue to a 

particular underlying disease. Plane xanthomas in a normo-

lipemic patient with favored distribution on the neck, upper 

trunk, and flexural folds should prompt a search of underly-

ing hematological disorders such as monoclonal gammopathy 

or lymphoproliferative disease [1,2]. Plane xanthomas can