The global effort to eradicate poliovirus and limit polio outbreaks is a shared responsibility that continues in various countries as of late July 2025.
Despite significant progress, the detection of ongoing polio cases highlights the persistent risk to children.
According to the U.S. Centers for Disease Control and Prevention (CDC), 41 countries remain at risk for polio outbreaks, including the Islamic Republic of Pakistan.
As of July 27, 2025, local media reported that the Regional Reference Laboratory for Polio Eradication at the National Institute of Health (NIH) in Islamabad confirmed three additional cases of polio.
So far this year, 17 reported cases have been identified, and the total number of cases for 2024 currently stands at 74.
In Pakistan, a vaccination campaign is currently underway in the bordering Union Councils of District Chaman and six districts of Balochistan, starting in late July 2025.
The CDC emphasizes that the only adequate protection against polio is through repeated doses of the polio vaccine for every child under the age of five, with optional booster doses for adults traveling to endemic areas.
In the United States, the IPV polio vaccine is offered at clinics and pharmacies.
As we mark World Hepatitis Day, WHO calls on governments and partners to urgently accelerate efforts to eliminate viral hepatitis as a public health threat and reduce liver cancer deaths.
“Every 30 seconds, someone dies from a hepatitis-related severe liver disease or liver cancer. Yet we have the tools to stop hepatitis”, said Dr Tedros Adhanom Ghebreyesus, WHO Director-General.
Viral hepatitis – types A, B, C, D, and E – are major causes of acute liver infection. Among these only hepatitis B, C, and D can lead to chronic infections that significantly increase the risk of cirrhosis, liver failure, or liver cancer. Yet most people with hepatitis don’t know they’re infected. Types B, C, and D affect over 300 million people globally and cause more than 1.3 million deaths each year, mainly from liver cirrhosis and cancer.
Hepatitis D now classified as carcinogenic
The International Agency for Research on Cancer (IARC) recently classified hepatitis D as carcinogenic to humans, just like hepatitis B and C. Hepatitis D, which only affects individuals infected with the hepatitis B, is associated with a two- to six-fold higher risk of liver cancer compared to hepatitis B alone. This reclassification marks a critical step in global efforts to raise awareness, improve screening, and expand access to new treatments for hepatitis D.
“WHO has published guidelines on testing and diagnosis of Hepatitis B and D in 2024, and is actively following the clinical outcomes from innovative treatments for hepatitis D,” said Dr Meg Doherty, incoming Director of Science for Health at WHO.
Treatment with oral medicine can cure Hepatitis C within 2 to 3 months and effectively suppress hepatitis B with life-long therapy. Treatment options for hepatitis D are evolving. However, the full benefit of reducing liver cirrhosis and cancer deaths can only be realized through urgent action to scale up and integrate hepatitis services – including vaccination, testing, harm reduction, and treatment – into national health systems.
Latest data and progress
Encouragingly, the majority of low- and middle-income countries (LMICs) have strategic plans on hepatitis in place and progress in national hepatitis responses is increasing:
in 2025, the number of countries reporting national hepatitis action plans increased from 59 to 123;
as of 2025, 129 countries have adopted policies for hepatitis B testing among pregnant women, up from 106 reported in 2024; and
147 countries have introduced the hepatitis B birth dose vaccination, an increase from 138 in 2022.
However, critical gaps remain in service coverage and outcomes, as stated in the 2024 Global Hepatitis Report:
Testing and treatment coverage remain critically low; only 13% of people with hepatitis B and 36% with hepatitis C had been diagnosed by 2022.
Treatment rates were even lower – 3% for hepatitis B and 20% for hepatitis C – well below the 2025 targets of 60% diagnosed and 50% treated.
Integration of hepatitis services remains uneven: 80 countries have incorporated hepatitis services into primary health care; 128 into HIV programmes and just 27 have integrated hepatitis C services into harm reduction centres.
The next challenge will be to scale up the implementation of prevention, testing and treatment coverage. Achieving WHO’s 2030 targets could save 2.8 million lives and prevent 9.8 million new infections. With declining donor support, countries must prioritize domestic investment, integrated services, better data, affordable medicines, and ending stigma.
Forging new partnerships
To mark World Hepatitis Day, WHO is partnering with Rotary International and the World Hepatitis Alliance to strengthen global and local advocacy. This year’s campaign “Hepatitis: Let’s break it down” demands action to confront the rising toll of liver cancer linked to chronic hepatitis infections. It also calls for decisive steps to dismantle persistent barriers – from stigma to funding gaps – that continue to slow progress in prevention, testing, and treatment.
Through a joint webinar and coordinated outreach, the partnership underscores the vital role of civil society and community leadership, alongside governments, in sustaining momentum and accelerating progress toward hepatitis elimination.
On World Hepatitis Day, the World Health Organization reiterates its support for Pakistan to tackle the highest burden of hepatitis C globally, with 10 million of the 60 million cases worldwide.
Only 25–30% of the people affected by Hepatitis B and C in Pakistan know it, meaning the vast majority do not undergo testing and do not seek life-saving treatment. Photo: WHO Pakistan/Sara Akmal28 July 2025, Islamabad, Pakistan – On the occasion of World Hepatitis Day, the World Health Organization (WHO) is calling for urgent action to fight a disease that continues to silently cause liver damage and cancer. With 10 million of the 60 million estimated cases worldwide, Pakistan has the heaviest burden of hepatitis C globally. The country also has an estimated 3.8 million people living with hepatitis B. Only 25–30% of the people affected know it, which prevents them from receiving life-saving treatment.
Under the theme “Let’s break it down”, WHO is urging policymakers and health authorities worldwide to simplify, scale up and integrate hepatitis services into national health systems – including vaccination, safe injection practices, harm reduction, and especially testing and treatment. The goal: ending hepatitis as a public health problem by 2030.
WHO reiterates its full support for Pakistan’s efforts to fight the disease, including the Prime Minister’s National Programme for the Elimination of Hepatitis C Infection. The Programme aims to test 50% of the eligible population (82.5 million people aged 12 years and above) and treat 5 million people by 2027.
“WHO will continue to fully support Pakistan in its journey to combat hepatitis and reinforce prevention, detection, and treatment, ensuring that we protect the most vulnerable populations to leave no one behind,” said WHO Representative in Pakistan Dr Dapeng Luo.
Hepatitis B and C are preventable and treatable. However, if left untreated, they can lead to medical complications – including liver cancer – and death. In Pakistan, the most common modes of transmission are unsafe procedures and materials used during blood transfusions – the result of unregulated private blood banks and a lack of universal screening, injections with re-used and non-sterile syringes and needles, surgical procedures, dental care, body piercing and tattooing, and shaving – including at barber shops.
Globally, chronic viral hepatitis causes 1.3 million deaths every year, mostly from liver cancer and cirrhosis. That equals 3,500 deaths every day.
WHO will continue to stand side by side with Pakistan to provide science-based guidance and support to strengthen prevention – including the vaccination of newborns against hepatitis B within 24 hours, and diagnosis and treatment for all, no matter where they live or who they are.
About WHO
Founded in 1948, WHO is the United Nations agency that connects nations, partners, and people to promote health, keep the world safe and serve the vulnerable. We work with 194 Member States in 150+ locations – so everyone, everywhere, can attain the highest level of health. WHO has been present in Pakistan – founding member of the Organization – since 1960. For more information, visit https://www.emro.who.int/countries/pak/index.html. Follow WHO Pakistan on Twitter and Facebook.
For additional information, please contact:
Maryam Yunus, National Professional Officer – Communications, WHO Pakistan,
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
(copying
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
).
José Ignacio Martín Galán, Head of Communications, WHO Pakistan,
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
New study reveals the real step count for a longer life
A research conducted by the University of Sydney claims that the longstanding recommendation to walk 10,000 steps a day for optimal health may be overkill.
Researchers claim that walking just 7,000 steps daily nearly gives the same benefit as hitting the 10,000-step mark and can also slash the risk of death by 47%.
Published in The Lancet Public Health, the study analyzed 57 studies across 10+ countries, tracking step counts and the health outcomes linked to it.
The study led by professor Melody Ding discovered that walking 7,000 steps per day significantly lower risks of heart diseases, dementia (by 38%), type 2 diabetes (by 22%), depression, and cancer.
The study also noted that even 4000 steps marked measurable health benefits as compared to low activity levels. Beyond 7,000 steps, benefits still increase but at a slower rate.
The 10,000-step goal originated from a 1960s Japanese marketing campaign for pedometers and was not claimed by any medical research. Later, the notion was adapted as a trend and had broader positive perceptions among people.
The new study compared the benefits of the 10,000 steps milestone with 7,000 steps and found no significant improved health benefits. But in terms of practicality, 7,000 steps is more achievable for most people.
The lead researcher, however, encouraged 2000 to 4000 steps as compared to no or minimum physical activity.
Ding said: “Any increase in daily steps, even modest ones like 4,000 steps, delivers health benefits compared to very low activity levels. When possible, targeting around 7,000 steps per day can substantially reduce risks for many chronic diseases and adverse health outcomes.”
Ding further noted: “Higher step counts beyond 7,000 may add extra benefits, but the improvement rate slows.”
While talking about the benefits of physical activity and walking, researchers stated: “It’s also important to note that while walking offers great health benefits, it is not a complete ‘package’ in itself. Everyday movements count — like getting off the bus a stop earlier or choosing stairs over elevators. Try to also incorporate strength training and mobility exercise into a weekly routine for more complete health benefits.”
The study also has limitations, including potential health risks (e.g., in older adults) that require further research. Future studies on step counts should focus on variations based on age, health status, and region.
Thank you. Listen to this article using the player above. ✖
Want to listen to this article for FREE?
Complete the form below to unlock access to ALL audio articles.
Knowing how many people are vaccinated against an existing or re-emerging threat is a key factor guiding public health decisions, but such information is often sparse or non-existent in many regions, according to researchers at Penn State. Now, in collaboration with a team at the World Health Organization, the researchers have developed a new method to estimate and predict regional measles vaccination coverage levels even when accurate or timely survey data on vaccination is not available. The method uses data that is routinely collected when potential measles cases present at clinics to model vaccination coverage and can be used to guide public health interventions to slow or prevent measles outbreaks.
A paper describing the research appeared recently in the journal Vaccine.
“The measles vaccine is highly effective, providing long-lasting protection from the disease, but we still have outbreaks, and the disease causes over 100,000 deaths each year worldwide because of disparities in vaccine distribution,” said Deepit Bhatia, graduate student in biology in the Eberly College of Science and at the Center for Infectious Disease Dynamics at Penn State and first author of the paper. “The Centers for Disease Control and Prevention recently reported over 1,300 confirmed cases in the United States for the first half of 2025 — the highest number in 33 years. Accurate information on vaccination levels is crucial to guide public health interventions but the sources we have for this information are imperfect.”
Researchers use two main sources for information on vaccination coverage. The Demographic and Health Surveys (DHS) collects health data at the household and individual level in 90 low- and middle-income countries. Formerly funded by the United States Agency for International Development (USAID) the program is considered the gold-standard for accuracy, according to the researchers. These surveys are expensive and time-consuming to perform and are therefore only produced every three to five years. Outside of these large-scale surveys, countries produce administrative vaccinations coverage estimates based on the number of vaccine doses administered to a certain age group in the region. These administrative estimates are produced more frequently, but they are not as accurate as the DHS and can be biased.
“The DHS produce amazing data, but it’s analogous to U.S. Census data in that it is only done every few years,” said Matt Ferrari, director of the Penn State Center for Infectious Disease Dynamics, professor of biology and leader of the research team. “The census is done every 10 years and takes two years to complete. By the time it’s done, it’s out of date. But it’s too expensive to do more frequently. This is how vaccination coverage has been evaluated, particularly in low- and middle-income countries, places where these diseases have the largest impact.”
When developing their new method, the researchers said they wanted to find a way to split the difference between the highly accurate but expensive and potentially out-of-date surveys, and the more timely but less accurate administrative coverage estimates. They built a model using data that is routinely collected when patients are treated for potential measles cases at clinics. They used the mean age of the patients, their vaccination status as reported when at the clinic and whether the suspected cases actually were measles, rather than another disease with similar symptoms.
“We know that these measures are associated with vaccination coverage levels,” Bhatia said. “For example, in regions with high vaccination levels, young children are less likely to come in contact with the disease and the mean age of cases at the clinic will be higher.”
The research team used the three indicators as predictors to train a regression model that could best predict the gold-standard DHS data. Importantly, they withheld the most recent DHS data to later use as a stronger test of the predictive power of their method. They then used their model to predict vaccination coverage for the period covered by the latest DHS data and found that it was highly correlated.
“We found that the predictions of our method fit better with the DHS data than the administrative vaccination coverage estimates did,” Bhatia said. “Since our method uses routinely collected information that is readily available to researchers and public health officials, it provides a cheap and more easily accessible methodology to estimate vaccination coverage for a region that can be done quickly and can help inform policy in a timelier way.”
Recent changes to funding for the DHS have increased the relevance of the new method, according to Ferrari.
“Although this wasn’t the case when we began this research, the DHS program is currently on pause,” Ferrari said. “DHS was primarily funded by USAID, and we don’t know when or if they will be started again. Our method can hopefully help provide a stopgap.”
Reference: Bhatia D, Crowcroft N, Antoni S, et al. Prediction of subnational-level vaccination coverage estimates using routine surveillance data and survey data. Vaccine. 2025;60:127277. doi: 10.1016/j.vaccine.2025.127277
This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source. Our press release publishing policy can be accessed here.
WASHINGTON, (UrduPoint / Pakistan Point News / WAM – 28th Jul, 2025) A research team at the University of Texas at Austin unveiled a non-invasive device that continuously measures hydration levels in real time and wirelessly transmits the data to a smartphone.
“Dehydration is a silent threat that affects millions of people every day,” said Professor Nanshu Lu, who led the research at UT Austin’s Cockrell school of Engineering. “Our wearable sensor provides a simple, effective way to monitor hydration levels in real time, empowering individuals to take proactive steps to stay healthy and perform at their best.”
The sensor uses a method called bioimpedance, which sends a small, safe electrical current through the body via strategically placed electrodes.
The current’s flow depends on how hydrated the tissues are, hydrated tissue allows the current to pass easily, while dehydrated tissue resists the flow.
To validate the device, the research team conducted multiple experiments, including a diuretic-induced dehydration study and a 24-hour real-life trial. Participants were given medication to promote fluid loss.
Their hydration levels were monitored via the wearable and compared to urine samples.
The device showed a strong correlation between changes in arm bioimpedance and total body water loss. The findings were published in the Proceedings of the National academy of Sciences.
The new sensor could offer an accessible and wearable alternative to traditional hydration tracking methods, such as urine or blood analysis, which are invasive, time-consuming and impractical, the researchers noted.
Hydration is known to be essential for regulating body temperature, maintaining organ function and supporting many other vital processes. Even mild dehydration can impair concentration and performance, while severe dehydration may lead to serious health problems like heatstroke, kidney stones and cardiovascular issues.
Beyond everyday use, the researchers believe the technology could benefit patients with chronic dehydration, kidney disease or heart conditions. Athletes, too, could use the wearable to stay safe and perform optimally, especially in hot weather.
16 people with AIDS identified during house-to-house visits in Kyrgyzstan
AKIPRESS.COM – The medical workers made house-to-house visits in Kyrgyzstan to identify the prevalence of hepatitis B and C, HIV among the population, Director of the Republican Center for Monitoring Hemocontact Viral Hepatitis and HIV Umut Chokmorova reported on July 26.
A total of 7,894 people were checked in different houses across the country. 5,247 of them were adults, and 2,647 children aged 5-17 years. A total of 2,072 adults with hepatitis B, 394 with hepatitis C and 16 people with AIDS were identified. 11 people with HIV are registered, and the rest are new cases.
Your patients with chronic obstructive pulmonary disease (COPD) may need help not just coping with their condition but also managing it in their workplace.
The symptoms of COPD, a lung and airway condition that causes shortness of breath, fatigue, and persistent cough, may interfere with some job responsibilities, according to several pulmonologists Medscape Medical News consulted as well as studies published in the past few years about COPD in the workplace.
The Mayo Clinic reported that symptoms for most patients with COPD begin when they are at least 40 years, so well into their working years.
Patients with COPD must continuously monitor if their condition affects their job performance and how potential workplace exposures to toxic chemicals or dust, and hazards such as stairs, worsen their breathing issues, the pulmonologists told Medscape Medical News.
Several recent studies evaluated how workplace exposures to gases, vapors, dust, and fumes raised employees’ risks of developing COPD, worsened their symptoms, or increased their chances of complications from the chronic disease.
To combat such outcomes, pulmonologists share ways they teach their patients about navigating their workplace environment, recognizing hazards, understanding workplace protections, and seeking help.
Weighing Work Options
Whether a COPD patient can keep up with the job requirements depends on the person and their worksite experience, said David Mannino, MD, a pulmonologist and chief medical officer for the COPD Foundation, and chair of the Department of Occupational Medicine and Environmental Health at the University of Kentucky, Lexington, Kentucky.
“Some jobs are more physically demanding than others,” he said. “Every patient has a unique situation and there’s never a one-size-fits-all approach. It’s very individualized.”
Mannino said he’s had patients who worked in coal mines or warehouses, and had to navigate those dusty and dirty environments, which can be difficult for patients with COPD.
David Mannino, MD
If they can’t function reasonably well or keep up with the demands of the job, they may need to ask their employer for special accommodations such as switching to a different position or changing worksites, said Mannino, who sees patients several times.
“Some of my patients are on oxygen and that’s fine if you’re at a desk job. You can wear oxygen and that’s not a problem.” In other settings, it might be more difficult or impossible, he said.
“If you have a patient who is a woodworker and he is self-employed and he uses respiratory protection, that he can do reasonably well. I’ve had some older patients who work at the university in desk jobs and so they can continue to work with no real changes in their responsibilities or schedules.”
Some people with COPD may choose to retrain for careers where there aren’t as many physical demands, he said.
Mannino treated an older patient who was a plumber and could no longer keep up with some of the physical aspects of his job, so he was able to retire.
Environmental Triggers
Cleveland Clinic Pulmonologist Maeve MacMurdo, MD, said she spends time with patients with COPD evaluating their job, their challenges in the workplace with the disease, and potential triggers.
“So often people find that common triggers are things like strong perfumes or chemical cleaners,” she said. Incense and candles might also trigger COPD for some.
Weather also plays a major role in the lives of patients with COPD.
“The humidity definitely impacts a lot of patients, so the air quality is one thing I tell them, when you wake up in the morning, look at the humidity for the day,” said Rohan Mankikar, MD, a pulmonologist with NYU Langone Health, New York City. “The sweet spot for my COPD patients is like between 40%-70%, so if the humidity is above 70%, they might feel it more.”
Maeve MacMurdo, MD
On cold days, humidity < 20% might also affect patients with COPD, he said.
“But even days that it rains, snows, [they are] exposed to environmental changes such as wildfire smoke, I have patients that come in with COPD flares or exacerbations.”
Patients should also check the allergen, pollen counts, and the air quality index for the day, Mankikar said.
“This is just something simple they can do before driving to work because sometimes you drive with the windows down and you might be inhaling pollen. The job site could be construction and there’s exposure to dust,” he said.
Potential workplace hazards are myriad, he said. From copy machines that accumulate dust to beauticians who get exposed to different chemicals and smells, it all could possibly trigger an episode. Mankikar said some of his patients wear a mask when they can.
Patients should note what triggers their COPD and if it improves in different environments, Mankikar said. They should survey their work area to ensure it’s safe for them. For instance, the air quality or humidity in the room. If it’s a confined space with poor ventilation or an old building with mold that might require mold remediation.
One of the most important triggers to address is smoking, which is the primary cause of COPD, he said.
“That’s the biggest allergen for them and they might not realize it because they’re saying: ‘Well I’m used to this and did this [most of] my life.’ But it weakens the immune system when you’re actively smoking and creates more mucus production, which then acts like a glue for dust and pollen exposure.”
Workplace Protections
The Americans with Disabilities Act (ADA) protects employees with substantial breathing difficulty and requires employers to provide “reasonable accommodations” or adjustments to the employee’s role.
Though the ADA doesn’t list specific medical conditions such as COPD, it considers breathing a physical impairment that substantially limits or restricts a major life activity covered under the act. Major life activities include respiratory functions along with performing manual tasks, working, learning, reading, thinking, and communicating.
To be protected, an employee must have a record of or be regarded as having a substantial impairment.
If an employee’s COPD stops or limits their ability to work effectively, they can apply for disability benefits through the Social Security Administration (SSA). COPD is listed among the respiratory disorders covered under the SSA’s list of covered impairments.
Monthly SSA disability benefits can be used to pay for food, clothing, housing, medical bills, medications, childcare, and training if an employee wants to return to work.
To qualify, the government requires medical evidence to document the severity of the respiratory disorder such as with pulmonary function tests, including spirometry, which measures ventilation of the lungs, or pulse oximetry, which measures oxygen saturation of peripheral blood hemoglobin.
What Help Patients May Need
In addition to portable oxygen, patients may have to request access to therapeutic options to help them perform their job functions, Mannino said. Those might include access to medications that can be used at work, such as handheld inhalers or nebulizers.
If a patient becomes short of breath when they climb stairs and that’s a job requirement, they may have to ask their employer to modify their duties or look for another position within the company, resign or retire, he said.
It’s up to the employer to decide whether the request for accommodation is reasonable, Mannino said. If you’re a welder and you need to be on oxygen, that’s not really safe because it can create a fire hazard, he said.
“I think employers want to typically work with their employees…and that it’s possible to make the workplace better for that person who has COPD.”
If the company has an occupational health specialist in their human resources department, they may be able to assess the employee’s needs and offer suggestions, said Francesca Polverino, MD, PhD, a pulmonologist and medical spokesperson for the American Lung Association.
For some employees, access to a wheelchair may help them navigate the distances they might have to traverse at work, especially if they are carrying oxygen, said Polverino, who is also a professor of medicine at the Baylor College of Medicine.
Francesca Polverino, MD, PhD
Patients with COPD also would benefit from further education of their coworkers and supervisors about the disease because there’s often a stigma associated with it, Polverino said. Compared with asthma, which tends to be inherited or unintentionally acquired, COPD is often caused by a preventable addiction — smoking.
It’s also not considered as alarming as other chronic diseases because COPD worsens slowly over a longer period, she said. For these reasons, workers with COPD may be reticent to ask for help, she added.
MacMurdo said “reasonable accommodation” from an employer might include a private office, an air purifier, working from home or having a flexible schedule. She agreed that not all work adaptations will be possible, but employees can brainstorm solutions with their doctors.
Patients should keep a log of what they are doing and when they experience symptoms to help doctors identify triggers and come up with workarounds they can suggest to their employers, MacMurdo said.
Ideally, patients should discuss with their doctors what they recommend and decide what’s practical for the particular job to control COPD symptoms, she said.
How to Ask for Help
Mankikar said he’s written letters for patients to take to their employer asking if it’s possible for them not to be exposed to certain chemicals or dust that might exacerbate their COPD.
“For example, if the patient is a teacher and has COPD and they’re doing construction [nearby], then I might have them try to teach a different class that’s away from the construction site, so they’re not in the hallways inhaling the dust.”
Patients often request a doctor’s note to leave early from work for pulmonary rehabilitation, Mankikar said.
“Unfortunately, those facilities are only open Monday through Friday from 9 to 5…so that’s an example of writing a letter to make that accommodation happen to strengthen their lungs.”
Employers tend to be very responsive to his notes, he said.
“The moment they know that some of these dust exposures can increase their [employee’s] risk of COPD they want to make accommodation for them because they don’t want the employee to miss work due to the illness.”
Employers know that if their employees are exposed to chemicals or allergens, there’s also a financial burden they might face, Mankikar said.
If the employer is willing to work with the patient, they might move them to an administrative role instead of a direct occupational one. He cited a patient who worked for a landscaping company and managed other landscapers. The exposure to allergens raised his risk for COPD flareups, so his employer agreed to move him to an area that’s well-ventilated and on days when the pollen count was high, he was able to work at a different site.
These resources also may help patients navigate COPD in the workplace:
How to Manage COPD’s Impact on Your Job
Early Warning Signs of Work-Related COPD | American Lung Association
Lung Health on the Job | NHLBI, NIH
Roni Robbins is a freelance journalist and former editor for Medscape Business of Medicine. She’s also a freelance health reporter for The Atlanta Journal-Constitution. Her writing has appeared in WebMD, HuffPost, Forbes, New York Daily News, BioPharma Dive, MNN, Adweek, Healthline, and others. She’s also the author of the multi-award-winning novel Hands of Gold: One Man’s Quest to Find the Silver Lining in Misfortune.
Xanthoma is a lesion characterized by the deposition of lipid components in the skin tissues. The skin lesions of xanthoma include papules, plaques, and nodules. Its occurrence is closely associated with hyperlipidemia,1 which has been found to be a risk factor for a variety of medical diseases such as acute pancreatitis and coronary heart disease. We present a case of a patient who visited a dermatology clinic with xanthomas as the initial manifestation. Blood test results revealed significantly elevated lipid levels. Despite aggressive treatment aimed at controlling these lipids, the patient unfortunately developed a potentially life-threatening case of acute pancreatitis.
Case Information
A 20-year-old female patient was admitted to the Department of Dermatology at our hospital due to yellowish-red papules on her trunk and limbs, accompanied by itching and pain for the past two weeks. The patient developed rashes on her trunk and limbs without any identifiable triggers, which she initially disregarded. Over the past two weeks, the rash progressively increased in size and number, accompanied by intermittent itching and pain. Physical examinations in the dermatology department revealed yellow or reddish semicircular papules that were either scattered or densely distributed on the skin of the trunk and limbs. These papules were firm to the touch and exhibited a smooth, non-scaly surface. Dermoscopy revealed orange-yellow structureless areas with dendritic capillary dilation, surrounded by vascular membranes (The lesions and dermoscopic findings are shown in Figure 1).
Figure 1 The patient’s skin lesions and dermoscopic (65x) photos.
The patient was obese with BMI >30. She was previously fit and denied any family history of diabetes mellitus or hyperlipidemia. Laboratory tests revealed the following results: triglycerides (TG) at 79.37 mmol/L, total cholesterol (CHOL) at 17.30 mmol/L, high-density lipoprotein (HDL-C) at 5.47 mmol/L, low-density lipoprotein (LDL-C) at 1.11 mmol/L, and fasting glucose (GLU) at 16.86 mmol/L. A skin biopsy indicated a significant infiltration of histiocytes in the superficial layer of the dermis and reticular layer, along with an increased number of foamy cells (Figure 2).
Figure 2 Pathological picture of the patient’s skin biopsy. (A) shows 20x HE staining, (B) shows 40x HE staining.
Dermatoscopy and pathology confirmed the diagnosis of eruptive xanthoma. According to the blood examination results of the patient, she can be diagnosed with mixed hyperlipidemia. The patient was subsequently transferred to the cardiology department for lipid-lowering therapy, which included an iloyumab injection. Five days later, the patient went to the surgery department with mid-upper abdominal pain. Blood tests revealed glucose levels of 27.8 mmol/L, cholesterol levels of 13.07 mmol/L, triglycerides at 68.29 mmol/L, HDL-C at 4.19 mmol/L, and LDL-C at 0.04 mmol/L (Table 1 illustrates the comparison of the results from the two blood tests). An abdominal CT scan indicated acute pancreatitis with scattered peripheral exudates. The diagnosis was hyperlipidemic pancreatitis (moderate to severe). The patient was discharged from the hospital with improvement following treatment of inhibition of pancreatic enzyme activity, lowering lipid levels, and adjusting blood glucose. After one week of follow-up blood examination, her total cholesterol decreased to 3.95 mmol/L, and triglycerides decreased to 2.66 mmol/L. The rash completely subsided, leaving significant hyperpigmentation.
Table 1 Examination Results of Blood Lipid Related Indicators of This Patient
Discussion
Xanthomas can be divided into primary and secondary. Familial xanthomas in primary xanthomas are often accompanied by abnormal lipid metabolism. Some xanthomas may also be related to some rare diseases.2 There is a potential pathophysiological link between eruptive xanthoma and hyperlipidemia and hyperglycemia.3 According to Frederickson hyperlipidemia classification, eruptive xanthoma associated hyperlipidemia can be seen in type 1 (increased chylomicrons), type 4 (increased very low density lipoprotein (VLDL)) and type 5 Hypertriglyceridemia.4 The abnormal metabolism of triglycerides leads to the increase of lipid composition in the circulation. Xanthomas may appear when the lipid composition deposited on the skin. Hypertriglyceridemic pancreatitis may be triggered by an increase in plasma triglyceride concentration, leading to local ischemia, inflammation, and the release of pancreatic enzymes. Similar cases have been reported in the literature, suggesting that eruptive xanthomas may serve as an early cutaneous marker of metabolic abnormalities.3
In this case, the patient presented to the dermatology department with cutaneous manifestations of xanthoma, which subsequently progressed to acute pancreatitis within a week, despite a rapid referral to an internal medicine specialist for aggressive treatment following the discovery of an extremely abnormal lipoglycemic state. This suggests that extreme hyperlipidemia (TG > 50 mmol/L) may exceed the conventional treatment threshold and necessitate more aggressive interventions. We also consider a correlation with the patient’s obesity, elevated BMI, and the lack of timely consultation regarding the presence of xanthomatous skin lesions. This underscores the importance of early recognition of the role of eruptive xanthomas as warning signs.5,6 Previous case reports have demonstrated that early presentation and intervention for patients with xanthomas in the dermatology department have been successful in preventing the progression to serious outcomes, such as pancreatitis.7 Therefore, dermatologists should pay closer attention to patients with eruptive xanthomas. They should conduct metabolic evaluations and interventions as early as possible, provide thorough patient education, and collaborate with specialists in cardiovascular medicine, endocrinology, and other internal medicine departments. This multidisciplinary approach aims to optimize disease management and enhance patient prognosis.
In addition, the literature indicates that other types of xanthomas or diseases with similar skin lesions with xanthomas may be associated with conditions such as multiple myeloma and histiocytosis.8,9 This suggests that the presence of xanthomas may have significant predictive value for various medical disorders, particularly metabolic disorders, and warrants further investigation and research.
Conclusion
The pathophysiological association between eruptive xanthomas and acute pancreatitis suggests a potential comorbid condition since both of them are closely related to hyperlipidemia. The high-fat state in the circulation not only leads to lipid deposits (xanthomas) on the skin, but also induces abnormal activation of pancreatic digestive enzymes and inflammatory responses. Eruptive xanthomas may serve as an early indicator of metabolic abnormalities and an increased risk of pancreatitis, particularly in individuals who are obese (BMI ≥ 30), present with sudden skin lesions that progress rapidly, and require immediate evaluation of their lipid profile. There is an urgent need to establish a comprehensive skin-metabolism pathway, which includes immediate lipid screening for patients with xanthomas, the development of an urgent intervention program for triglyceride levels exceeding 50 mmol/L, and patient education aimed at reducing metabolic risk in the obese population. This underscores the significance of this case report.
Data Sharing Statement
The data that support the findings of this study are available from the first author upon reasonable request (Yanling Zhu, [email protected]).
Consent Statement
The patient in this case signed an informed consent form and agreed to provide the case information and photographic images for the manuscript. The publication of case and image information does not require institutional approval.
Author Contributions
All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Funding
This study has no fund.
Disclosure
All authors have no conflicts of interest in this work.
References
1. Zak A, Zeman M, Slaby A, et al. Xanthomas: clinical and pathophysiological relations. Biomed Papers Med Faculty Univ Palacky Olomouc Czechoslovakia. 2014;158(2):181–188. doi:10.5507/bp.2014.016
2. De Schaetzen V, Richert B, De La Brassinne M. [Xanthomas]. Revue Medicale de Liege. 2004;59(1):46–50.
3. Vu PQ, Thiriveedi M, Patel S, et al. Case report: acute pancreatitis in an uncontrolled diabetic patient presenting with a skin rash later found to be eruptive xanthoma, a dermatological manifestation and diagnostic clue to recognizing hypertriglyceridemia as the cause of disease. Cureus. 2024;16(7):e64563. doi:10.7759/cureus.64563
4. Pai VV, Shukla P, Bhobe M. Combined planar and eruptive xanthoma in a patient with type lla hyperlipoproteinemia. Indian J Dermatol Venereol Leprol. 2014;80(5):467–470. doi:10.4103/0378-6323.140323
5. Marogi EP, Ohiomoba RO, Stone NJ. Eruptive xanthomas: importance of recognition to reduce delay of effective triglyceride reduction. Am J Med. 2022;135(4):444–447. doi:10.1016/j.amjmed.2021.09.026
6. Stark M, Stuart J. Eruptive xanthoma in the setting of hypertriglyceridemia and pancreatitis. Am J Emerg Med. 2018;36(8):1524.e5–.e7. doi:10.1016/j.ajem.2018.04.056
7. Munoz NR, Agwuegbo CC, Gauhar F. Eruptive xanthomas precipitated by severe hypertriglyceridemia from diabetes and alcohol use. Cureus. 2023;15(8):e43288. doi:10.7759/cureus.43288
8. Marien KJ, Smeenk G. Plane xanthomata associated with multiple myeloma and hyperlipoproteinaemia. Br J Dermatol. 1975;93(4):407–415. doi:10.1111/j.1365-2133.1975.tb06514.x
