Xanthelasma Clinical Presentation

  • Author: Hampton Roy Sr, MD; Chief Editor: Hampton Roy Sr, MD   more...
 
Updated: Oct 6, 2011
 

History

  • Xanthelasma are the most common type of xanthoma. They often present in the absence of xanthomas elsewhere on the body, although, histologically, they are the same.
  • Once plaques are established, they will remain static or increase in size.
  • Patients generally complain about aesthetic concerns.
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Physical

  • Xanthelasma or xanthoma palpebrarum usually are located on the medial side of the upper eyelids.
  • Lesions are yellowish and soft, and they form plaques.
  • Generally, these lesions do not affect the function of the eyelids, but ptosis has been known to occur.
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Causes

  • Approximately one half of individuals with xanthelasma have a lipid disorder.
    • Eruptive xanthomas can be seen in primary and secondary causes of hyperlipidemia.
    • Examples of primary genetic causes include familial dyslipoproteinemia, familial hypertriglyceridemia, and familial lipoprotein lipase deficiency.
    • Diabetes that is out of control is a common cause of secondary hyperlipidemia. However, most xanthelasma occur in normolipemic persons who may have low HDL cholesterol levels or other lipoprotein abnormalities.
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Contributor Information and Disclosures
Author

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Specialty Editor Board

Ron W Pelton, MD, PhD  Private Practice, Colorado Springs, Colorado

Ron W Pelton, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Society of Ophthalmic Plastic and Reconstructive Surgery, AO Foundation, and Colorado Medical Society

Disclosure: Nothing to disclose.

Simon K Law, MD, PharmD  Associate Professor of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Simon K Law, MD, PharmD is a member of the following medical societies: American Academy of Ophthalmology, American Glaucoma Society, and Association for Research in Vision and Ophthalmology

Disclosure: Nothing to disclose.

Mark T Duffy, MD, PhD  Consulting Staff, Division of Oculoplastic, Orbito-facial, Lacrimal and Reconstructive Surgery, Green Bay Eye Clinic, BayCare Clinic; Medical Director, Advanced Cosmetic Solutions, A BayCare Clinic

Mark T Duffy, MD, PhD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, American Society of Ophthalmic Plastic and Reconstructive Surgery, Sigma Xi, and Society for Neuroscience

Disclosure: Allergan - Botox Cosmetic Honoraria Speaking and teaching

Lance L Brown, OD, MD  Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri

Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD  Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Tracey A Schmucker, MD, to the development and writing of this article.

References

  1. Christoffersen M, Frikke-Schmidt R, Schnohr P, et al. Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study. BMJ. Sep 15 2011;343:d5497. [Medline]. [Full Text].

  2. Santaella RM, Ng JD, Wilson DJ. Carbon Dioxide Laser-Induced Combustion of Extravasated Intraocular Silicone Oil in the Eyelid Mimicking Xanthelasma. Ophthal Plast Reconstr Surg. Feb 22 2011;[Medline].

  3. Doi H, Ogawa Y. A new operative method for treatment of xanthelasma or xanthoma palpebrarum: microsurgical inverted peeling. Plast Reconstr Surg. Sep 1998;102(4):1171-4. [Medline].

  4. Haygood LJ, Bennett JD, Brodell RT. Treatment of xanthelasma palpebrarum with bichloracetic acid. Dermatol Surg. Sep 1998;24(9):1027-31. [Medline].

  5. Basar E, Oguz H, Ozdemir H, et al. Treatment of xanthelasma palpebrarum with argon laser photocoagulation. Argon laser and xanthelasma palpebrarum. Int Ophthalmol. Jan 2004;25(1):9-11. [Medline].

  6. Bergman R. Xanthelasma palpebrarum and risk of atherosclerosis. Int J Dermatol. May 1998;37(5):343-5. [Medline].

  7. Egan CA, Patel BC, Morschbacher R, et al. Atypical lymphoid hyperplasia of the eyelids manifesting as xanthelasma-like lesions. J Am Acad Dermatol. Nov 1997;37(5 Pt 2):839-42. [Medline].

  8. Gladstone, Geoffrey, Myint, Shoib. Xanthelasma. In: Roy FH and Fraunfelder FT, eds. Current Ocular Therapy. Vol. 5. 2000:452-3.

  9. Howard GR. Xanthelasma. In: Roy FH, ed. Masters Technique in Ophthalmic Surgery. 1995:520-2.

  10. Ozdol S, Sahin S, Tokgozoglu L. Xanthelasma palpebrarum and its relation to atherosclerotic risk factors and lipoprotein (a). Int J Dermatol. Aug 2008;47(8):785-9. [Medline].

  11. Usatine RP. A cutaneous manifestation of a systemic disease. West J Med. Feb 2000;172(2):84. [Medline].

  12. Ustunsoy E, Demir Z, Coskunfirat K, et al. Extensive bilateral eyelid ptosis caused by xanthoma palpebrarum. Ann Plast Surg. Feb 1997;38(2):177-8. [Medline].

 
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Case presentation of excision of recurrent xanthelasma. Recurrent xanthelasma bilateral upper lids; previous excision combined with blepharoplasty; patient insistent on repeat excision and blepharoplasty; advised of lagophthalmos risk due to medial position and lack of medial dermatochalasis.
Close-up view of recurrent xanthelasma right upper lid. Note the scar from previous excision by a plastic surgeon. Careful examination reveals subtle infiltration in the lateral aspect of scar.
Xanthelasma. External view, 1 week after surgery. Sliding and rotational flaps from residual lateral dermatochalasis used for medial excisional gap.
Xanthelasma. Top image, 4 weeks after surgery; lower image, before surgery.
 
 
 
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