Xanthelasma Clinical Presentation

Updated: Mar 02, 2021
  • Author: Andrew A Dahl, MD, FACS; Chief Editor: Edsel B Ing, MD, MPH, FRCSC, PhD, MA  more...
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Presentation

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

Many 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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