Signification des plis palmaires orangés dans l’évaluation des dyslipidémies
After a brief review of cardiovascular risk factors and lipid metabolism, classification of dyslipidemias, the pathophysiology of xanthomas as well as dysbetalipoproteinemia will be discussed.  This dyslipidemia which is characterized by the accumulation of remnants particules, generally secondary to an abnormal apolipoprotein E, is highly atherogenic, both at the peripheral vascular and coronary levels.  The striated palmar xanthomas, defined as a yellow to orange (sometimes brownish) coloration of the palmar and digital folds, are considered pathognomonic of this formerly called type III dyslipidemia. By studying an adult Caucasian population from the Saguenay–Lac Saint-Jean region, we were able to demonstrate a prevalence of 18.8% of orange palmar folds in patients with dysbetalipoproteinemia. Also, this study allowed to shed light on the absence of criteria for dysbetalipoproteinemia in 10.7% of subjects with this type of xanthoma.  These data suggest that the expression of striated palmar xanthomas is associated with the presence of a sustained or recurrent accumulation of remnants. The accumulation of these remnants is possible in a broad spectrum of lipid disorders where there is interference in the hydrolysis or clearance of the remnants, including postprandial dyslipidemia, chylomicronemia, partial lipoprotein lipase deficiency and familial hypercholesterolemia mainly in homozygotes. Clinical research of striated palmar xanthomas could provide additional information in the evaluation of cardiovascular risk as a marker of an accumulation of remnants which, for their part, have been shown to confer an increased cardiovascular risk, both in primary prevention and secondary.
Remnants Apolipoprotein E Cardiovascular disease Dyslipidemia diagnosis Palmar striated xanthoma Remnant lipoprotein