Xanthomas or Molluscum?

Xanthomas or Molluscum?

Knowing the difference can save a life

November is National Healthy Skin Month so it feels like the right time to address a common misconception in the world of familial hypercholesterolemia (FH). Many of the stories that come from our Family Heart community involve a trip to the dermatologist.

What we hear from our community members is they discover xanthomas on their child’s skin, but the pediatrician and/or dermatologist initially misdiagnoses them as molluscum.

So, let’s look at the difference between the two skin conditions.

xanthomas and xanthelasmas

Above: xanthomas
Below: xanthelasmas


Above: molluscum


A xanthoma is a cholesterol deposit under the skin. They appear as “peanut-butter-looking” bumps or lumps around the knuckles, elbows, and knees. They form when extra cholesterol is deposited on tendons or under the skin. There is a type that forms around the eyes, and those are called “xanthelasmas.”

Xanthomas can vary in size – some are as tiny as pinheads, and some are as large as grapes. They typically aren’t painful and appear in clusters around the body.

The lumps themselves aren’t dangerous, but show that there is an underlying condition, like Heterozygous FH and Homozygous FH (HoFH). When these are present in children, it can be more indicative of HoFH. It is critical to address this condition as soon as possible by having a lipid panel done and starting aggressive treatment.

Many who begin cholesterol-lowering treatment see their xanthomas fade or even disappear.


Molluscum is a common virus that typically affects children. It is highly contagious and can appear on any part of the body. The infection tends to be very common in places like daycares, schools, and swimming pools.

The bumps from molluscum are small, firm to the touch, and range from pink, white, or flesh colored. They can sometimes develop another rash that looks like eczema. Some can develop small “pits” or dimples in their centers.

Molluscum can often become swollen, itchy, and uncomfortable.

This condition typically clears up on its own in six to 12 months. It is recommended to see a dermatologist soon to prevent spreading the infection.

The Difference Can Save More Families and More Hearts

Knowing whether an individual or child has xanthomas and not molluscum gives families valuable time to begin treatment as young as possible. With FH, time is of the essence and xanthomas are an important indicator that the time is now.

It’s also a way to treat an entire family. When FH is found in one family member, it is critical that all first-degree family members (parents, siblings, children) get their cholesterol checked.

With early and regular treatment, every individual with FH can live a longer, healthier life.

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