Xanthelasma (or xanthelasma palpebrarum) is a sharply demarcated yellowish collection of cholesterol underneath the skin, usually on or around the eyelids. Although not harmful or painful, these minor growths may be disfiguring and can be removed The appearance is of yellow flat plaques over the upper or lower eyelids. In other areas of the body the individual lesion would be called a xanthoma.
Usually not a problem, since colour and site are characteristic. Sometimes syringomas and milia may be misdiagnosed as xanthelasma. Syringomas are small papules on lower eyelids and are skin coloured. Large milial cysts are white and spherical. Xanthomas in other areas may appear more orange-yellow.
- Familial hyperlipiaemia. Patients with these lesions therefore frequently also have arcus senilis and xanthomas in other areas of the body.
- Ischeamic heart disease, but not peripheral vascular disease. Secondary hyperlipidaemia can also be an association, u
- Diabetes
- High cholesterol levels (specifically familial hypercholesterolemia)
- Primary biliary cirrhosis
- Menopause
Treatment with Cosmetic Radiosurgery and Laser
For Xanthelasma best cosmetic result is with cosmetic radiosurgery and laser:
Laser Treatment: We also employed for KTP laser (532 nm) for lesions which require 'tiding up' after cosmetic radiosurgical removal. Laser irradiation represents a minimally invasive, safe and effective treatment option for the reduction of xanthelasma palpebrarum without undesired side effects.
Other Option
The lesions can be left alone unless the patient wishes them removed for cosmetic reasons.
Other various options including surgical excision, chemical treatment with trichloracetic acid, carbon dioxide and argon laser treatment, and cryocautery.
Patients should have their fasting lipid levels checked, and those with hyperlipidaemia should have a formal cardiovascular risk assessment using appropriate charts. If the ten-year risk of cardiovascular disease is assessed at greater than 10%, lifestyle intervention should be considered as per primary prevention of cardiovascular risk protocols . If the risk is 20% or greater, intervention might include the use of aspirin and lipid lowering drugs.
The condition itself if harmless.
Up to 40% of lesions recur after treatment. Any associated comorbidity will of course affect prognosis.
Surgical excision and cryocautery may be available in primary care, but it is likely that the other treatment options will require secondary care referral.
St Mellion Cosmetic Clinic Branches in Manchester, Exeter and St Mellion near Plymouth