Xanthelasma Treatment & Management

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

Medical Care

Dietary restriction and pharmacologic reduction of serum lipids, although important in the overall care of a patient with abnormal lipids, show only limited response in the treatment of xanthelasma.

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Surgical Care

Numerous options are available for the removal of xanthelasma palpebrarum, including surgical excision, argon and carbon dioxide laser ablation, chemical cauterization, electrodesiccation, and cryotherapy.

  • Surgical excision
    • For small linear lesions, excision is recommended, as scarring should blend in with the surrounding eyelid tissue. Smaller bulging lesions can be "uncapped" and removed; then, the flap can be replaced and sutured.
    • Doi recommends using a surgical microscope, undermining between the tumor and the orbicularis oculi with an 11 blade, raising the flap and carefully removing the tumor piece by piece with microscissors from the reverse side, and then suturing the flap with 7-0 nylon.[3]
    • In full-thickness excisions, the lower lid is more prone to prominent scarring, as the tissue tends to be thicker. Simple excision of larger lesions risks eyelid retraction, ectropion, or the need for more complicated reconstructive procedures. Xanthelasma removal has been incorporated into cosmetic surgery; however, extending the incisional limits of a routine blepharoplasty increases the risk for ectropion formation. Case presentation of excision of recurrent xanthelCase 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 upperClose-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. 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; lowXanthelasma. Top image, 4 weeks after surgery; lower image, before surgery.
  • Carbon dioxide and argon laser ablation: Enhanced hemostasis, better visualization, lack of suturing, and speed have been cited as reasons to use this technique; however, scarring and pigmentary changes can occur.
  • Chemical cauterization: The use of chlorinated acetic acids has been found to be effective in the removal of xanthelasma. These agents precipitate and coagulate proteins and dissolve lipids. Monochloroacetic acid, dichloroacetic acid, and trichloroacetic acid have been used with good results. Haygood used less than 0.01 mL of 100% dichloroacetic acid with excellent results and minimal scarring.[4]
  • Electrodesiccation and cryotherapy can destroy xanthelasmas when they are superficial but may require repeated treatments. Cryotherapy may cause scarring and hypopigmentation.
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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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