What is xanthelasma?
Xanthelasma is the well-defined yellowish deposit of cholesterol in the upper and sometimes lower eyelids. They are obvious due to the sharp colour difference between the xanthelasma lesions and the surrounding eyelid skin. These lesions contain lipid-filled histiocytes (a type of white blood cell) that are found within the skin, are soft to touch and cannot be separated from the surrounding skin. Xanthelasmas occur in 1.1% of females and 0.3% of males1 .
How do xanthelasma manifest?
Xanthelasma often starts in the inner region of the upper eyelids. They tend to lie above the double-eyelid crease and sometimes enlarge or have multiple spots form on other parts of the upper eyelids with time. Their size ranges from 1 mm to 2 cm or more. Xanthelasma may later form in the lower eyelids, affecting the inner region preferentially. As a source of significant cosmetic disfigurement, many individuals seek the removal of their xanthelasma. They tend to be more common in individuals with hyperlipidemia (high cholesterol), thyroid dysfunction and diabetes mellitus2,3 and their peak onset is between 30 and 50 years.
Xanthelasma is a risk factor for atherosclerosis (cholesterol deposition in blood vessels) and ischemic heart disease, and is itself an independent cardiovascular risk factor.
How are xanthelasma managed?
An assessment of plasma lipids should be done – this includes triglycerides, cholesterol, low-density lipoprotein (LDL) (“bad” cholesterol, high-density lipoprotein (HDL) (“good” cholesterol), and apolipoprotein B100 levels.
1. Lifestyle measures
Regular physical exercise, a low-fat diet and cholesterol-lowering drugs are important in the management of xanthelasma. While these measures do not usually reduce the size of existing xanthelasma, they are important in improving the overall health of the individual and prevention of future heart disease.
2. Laser ablation
Carbon dioxide laser ablation is a suitable method of treatment for small xanthelasma due to the superficial nature of the lesions. Local anaesthesia is first administered beneath the xanthelasma to ensure a painless experience during the laser procedure. The laser utilizes a finely focused beam of light to destroy the perivascular foam cells while causing coagulation of blood vessels and prevention of bleeding. An additional benefit of the carbon dioxide ablative laser is the generation of heat energy, which shrinks the wound and reduces the eventual size of the scar. Topical creams and ointments are often prescribed to help maintain a moist wound environment, which promotes healing (epithelization). The wound heals in about a week. Patients are advised to avoid strong sunlight exposure and use sunblock diligently for two months post-procedure.
3. Surgical excision
Surgical excision is the most effective method of treatment and is indicated for moderate to large size xanthelasma. This is a simple procedure performed under local anaesthesia. The xanthelasma is excised and the wounds closed with fine sutures for optimal scars. Occasionally, very large xanthelasma may require staged excision or skin grafts following complete excision. Skin grafts, if required, are normally taken from the excess droopy portions of the same or opposite upper eyelid. Patients are advised to avoid strong sunlight exposure and use sunblock diligently for two months post-procedure. Postoperative topical silicone gel treatment produces optimal scar results.
REFERENCES
- Kavoussi H, Ebrahimi A, Rezaei M, Najafi B, Kavoussi R et al. Serum lipid profile and clinical characteristic of patients with xanthelasma palpebrum. An Bras Dermatol 2016;91:468-471.
- Gangopadhyay DN, Dey SK, Chandra M, Pal D, Chaudhary S. Serum lipid profile in xanthelasma. Indian J Dermatol 1998;54:53-56.
- Martinez-Rovira GR. Xanthelasma in association with hyperthyroidism. JAMA 1968;206(5),1081-1083.
