Xanthelasma

What is Xanthelasma?

Xanthelasma are flat or slightly raised yellowish plaques that develop on the eyelids — most commonly on the inner upper lid. They are made up of lipid-filled macrophages (foam cells) in the dermis and are the most common form of xanthoma. While they are entirely benign and cause no visual symptoms, many patients find them cosmetically undesirable. Approximately 50% of people with xanthelasma have elevated serum cholesterol or triglycerides, so systemic lipid investigation is always recommended.

Symptoms

• Yellowish flat or slightly raised plaques on the inner corners of the upper or lower eyelids
• Usually bilateral and symmetrical
• No pain, itch or visual disturbance
• Tendency to slowly enlarge over time

Causes

• Hyperlipidaemia (elevated cholesterol or triglycerides) — present in ~50% of cases
• Familial hypercholesterolaemia
• Diabetes mellitus
• Normal lipid levels in the remaining 50% — mechanism not fully understood

Diagnosis

Clinical diagnosis on inspection. Fasting lipid profile, blood glucose and liver function tests should be arranged to exclude systemic dyslipidaemia. Referral to a lipidologist or GP for cardiovascular risk assessment.

Treatment

Xanthelasma do not require treatment if the patient is not bothered by them. Cosmetic removal options include surgical excision (the most reliable method), carbon dioxide laser ablation, trichloroacetic acid chemical peel, and cryotherapy. Surgical excision by an oculoplastic surgeon provides the most predictable result. Recurrence can occur, particularly if the underlying lipid abnormality is not controlled.