Xanthelasma 

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

Background

Xanthelasma are yellow plaques that occur most commonly near the inner canthus of the eyelid, more often on the upper lid than the lower lid. Xanthelasma palpebrarum is the most common cutaneous xanthoma.

Xanthelasma can be soft, semisolid, or calcareous. Frequently, they are symmetrical; often, 4 lids are involved. Xanthelasma have a tendency to progress, coalesce, and become permanent.

The term xanthelasma is derived from the Greek xanthos (yellow) and elasma (beaten metal plate).

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Pathophysiology

One half of these lesions are associated with elevated plasma lipid levels. Some occur with altered lipoprotein composition or structure, such as lowered high-density lipoprotein (HDL) levels. They frequently occur in patients with type II hyperlipidemia and in the type IV phenotype.

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Epidemiology

Frequency

United States

Xanthelasma are rare.

International

Xanthelasma are rare in the general population.

Mortality/Morbidity

These lesions have no premalignant potential; however, see Differentials.

A study by Christoffersen et al finds that xanthelasmata can be a predictor of risk for myocardial infarction, ischemic heart disease, severe atherosclerosis, and death in the general population, independent of well known cardiovascular risk factors (eg, plasma cholesterol, triglyceride concentrations). On the other hand, they found that arcus corneae is not an important independent predictor of risk.[1]

Sex

In case studies of patients with xanthomatosis, a predominance of xanthelasma in women has been seen; women, 32%, and men, 17.4%.

Age

The age of onset ranges from 15-73 years, with a peak in the fourth and fifth decades.

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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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