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Xanthelasma Clinical Presentation

  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Edsel Ing, MD, FRCSC  more...
 
Updated: May 18, 2016
 

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 present with concerns of their appearance, rather than symptoms of discomfort or inflammation.

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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

Most individuals with xanthelasma have a lipid disorder. Many xanthelasma occur in normolipemic persons who may have low HDL cholesterol levels or other lipoprotein abnormalities.

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.

Secondary causes of hyperlipidemia include those related to various diets, drugs, disorders of metabolism, and some diseases. Diets rich in saturated fats and cholesterol, alcohol excess, and weight gain can cause severe but reversible hypercholesterolemia. Drugs that may cause altered lipid profiles include glucocorticoids, estrogens, anabolic steroids, some antihypertensive medications, retinoids, cyclosporine, cimetidine, certain antiepileptic drugs, and tamoxifen. Hypothyroidism is the most common secondary cause of hyperlipidemia after dietary causes are considered.

Uncontrolled diabetes is a common cause of secondary hyperlipidemia. 

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Contributor Information and Disclosures
Author

Andrew A Dahl, MD, FACS Assistant Professor of Surgery (Ophthalmology), New York College of Medicine (NYCOM); Director of Residency Ophthalmology Training, The Institute for Family Health and Mid-Hudson Family Practice Residency Program; Staff Ophthalmologist, Telluride Medical Center

Andrew A Dahl, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, American Intraocular Lens Society, American Medical Association, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, Medical Society of the State of New York, New York State Ophthalmological Society, Outpatient Ophthalmic Surgery Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Simon K Law, MD, PharmD Clinical Professor of Health Sciences, Department 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, Association for Research in Vision and Ophthalmology, American Glaucoma Society

Disclosure: Nothing to disclose.

Chief Editor

Edsel Ing, MD, FRCSC Associate Professor, Department of Ophthalmology and Vision Sciences, University of Toronto Faculty of Medicine; Consulting Staff, Hospital for Sick Children and Sunnybrook Hospital

Edsel Ing, MD, FRCSC is a member of the following medical societies: American Academy of Ophthalmology, American Association for Pediatric Ophthalmology and Strabismus, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Physicians and Surgeons of Canada, Canadian Ophthalmological Society, North American Neuro-Ophthalmology Society, Canadian Society of Oculoplastic Surgery, European Society of Ophthalmic Plastic and Reconstructive Surgery, Canadian Medical Association, Ontario Medical Association, Statistical Society of Canada, Chinese Canadian Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

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, AO Foundation, American Society of Ophthalmic Plastic and Reconstructive Surgery, Colorado Medical Society

Disclosure: Nothing to disclose.

Acknowledgements

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

References
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  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. 2011 Feb 22. [Medline].

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

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

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

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

  13. Ribera M, Pintó X, Argimon JM, Fiol C, Pujol R, Ferrándiz C. Lipid metabolism and apolipoprotein E phenotypes in patients with xanthelasma. Am J Med. 1995 Nov. 99 (5):485-90. [Medline].

  14. Bergman R, Kasif Y, Aviram M, Maor I, Ullman Y, Gdal-On M, et al. Normolipidemic xanthelasma palpebrarum: lipid composition, cholesterol metabolism in monocyte-derived macrophages, and plasma lipid peroxidation. Acta Derm Venereol. 1996 Mar. 76 (2):107-10. [Medline].

  15. Watanabe A, Yoshimura A, Wakasugi T, Tatami R, Ueda K, Ueda R, et al. Serum lipids, lipoprotein lipids and coronary heart disease in patients with xanthelasma palpebrarum. Atherosclerosis. 1981 Feb-Mar. 38 (3-4):283-90. [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.
Xanthelesma of four eyelids in patient with hyperlipidemia.
 
 
 
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