Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Xanthelasma

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

Background

Xanthelasma are yellowish 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. See the image below.

Xanthelesma of four eyelids in patient with hyperl Xanthelesma of four eyelids in patient with hyperlipidemia.

Xanthelasma can be soft, semisolid, or calcareous. Frequently, they are symmetrical. The upper lids are more frequently involved than the lower lids. 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).

See Can You Recognize Benign Skin Lesions From Cancerous Ones?, a Critical Images slideshow, to help identify various skin lesions.

Next

Pathophysiology

Xanthelasma are a type of xanthoma appearing on the eyelids. Xanthomas are depositions of yellowish cholesterol-rich material that can appear anywhere in the body in various disease states. They are cutaneous manifestations of lipidosis in which lipids accumulate in foam cells within the skin. They are often associated with hyperlipidemias, of both primary and secondary types. 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.

Previous
Next

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, arcus senilis of the cornea has been found not to be 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.

Previous
 
 
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
  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. 2011 Sep 15. 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. 2011 Feb 22. [Medline].

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

  4. Haygood LJ, Bennett JD, Brodell RT. Treatment of xanthelasma palpebrarum with bichloracetic acid. Dermatol Surg. 1998 Sep. 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. 2004 Jan. 25(1):9-11. [Medline].

  6. Bergman R. Xanthelasma palpebrarum and risk of atherosclerosis. Int J Dermatol. 1998 May. 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. 1997 Nov. 37(5 Pt 2):839-42. [Medline].

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

  9. Howard GR. Xanthelasma. 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. 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].

 
Previous
Next
 
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.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.