Xanthelasma

Xanthelasma

Xanthelasma is a medical condition characterized by the development of flat, yellowish growths on the eyelids, most commonly near the inner canthus (the corner where the eyelids meet). These growths are called xanthelasma palpebrarum and are a type of xanthoma, which is a broader term for skin lesions caused by the accumulation of fat in macrophages in the skin and more rarely in the layer of fat under the skin. Xanthelasma is primarily a cosmetic concern, but it can sometimes be indicative of underlying lipid metabolism disorders, such as hypercholesterolemia or other types of dyslipidemia.

Causes and Risk Factors

Xanthelasma is caused by the deposition of lipids (fats) under the skin. While anyone can develop xanthelasma, certain factors increase the risk, including:

• Genetic predisposition
• High levels of low-density lipoprotein (LDL, or "bad" cholesterol)
• Low levels of high-density lipoprotein (HDL, or "good" cholesterol)
• Liver diseases, such as primary biliary cirrhosis
• Diabetes mellitus
• Obesity
• Smoking
• Middle to older age

Symptoms

The primary symptom of xanthelasma is the presence of yellowish plaques on the eyelids, typically appearing symmetrically on both upper and lower lids. These plaques are soft to touch, have a flat surface, and their size can increase over time. While they are usually asymptomatic, some individuals may feel discomfort or embarrassment due to their appearance.

Diagnosis

Diagnosis of xanthelasma is primarily based on the clinical appearance of the lesions. A healthcare provider can often diagnose the condition by examining the skin. In some cases, a biopsy may be performed to confirm the diagnosis and rule out other conditions. Additionally, since xanthelasma can be associated with lipid disorders, blood tests to measure cholesterol and triglyceride levels may be recommended.

Treatment

Treatment for xanthelasma is not always necessary, especially if the lesions do not cause discomfort or emotional distress. However, for those who seek removal for cosmetic reasons or due to discomfort, options include:

• Surgical excision
• Laser therapy
• Cryotherapy (freezing the lesion with liquid nitrogen)
• Chemical peels
• Electrodessication (using electrical currents to remove the lesions)

It is also important to address any underlying lipid metabolism disorders or other risk factors to prevent the recurrence of xanthelasma. This may involve lifestyle changes, such as adopting a healthier diet, exercising regularly, and quitting smoking, as well as medication to manage cholesterol levels.

Prognosis

Xanthelasma is a benign condition that does not cause pain or significant health problems. However, since it can be associated with lipid metabolism disorders, individuals with xanthelasma should be evaluated for conditions like hypercholesterolemia. With appropriate treatment, the cosmetic appearance of xanthelasma can be significantly improved, although recurrence is possible.