Xanthelasma

Xanthelasma are soft, yellowish patches that form on or near the eyelids. The lesions often form in people who have high cholesterol or high lipid (fat) levels in the blood.

They are the most common subtype of xanthoma, which are cholesterol deposits that can present in any part of the body. Researchers do not know if xanthelasma palpebrarum (XP) is related to changes in lipid metabolism.

Cryotherapy, laser surgery and traditional surgery are the three most common ways to remove xanthelasma.

Intro

Xanthelasma are soft, yellowish patches or growths on or near the eyelids. If you notice these yellow patches around your eyes or on the inside corners of your eyelids, you might have a condition known as xanthelasma palpebrarum (XP).

The lesions form when cholesterol deposits (fat or lipid) build-up under the skin. Although xanthelasma themselves are not harmful, in rare cases they can signal heart disease. Pay attention to this skin condition and visit your doctor if it persists.

The formation of xanthelasma sometimes indicates other underlying conditions because of the link to high-lipid disorders. That means pointing them out to your doctor is important, especially if you have not been diagnosed with high cholesterol.

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Symptoms

The formation of soft, flat, yellowish patches around the eyes or on the inside corners of the eyelids is the main symptom of xanthelasma. The lesions may remain the same size or gradually increase over time. They can also merge, forming larger patches.

Xanthelasma are not usually itchy or painful, and they rarely affect vision or eyelid movement or function, although they can sometimes cause the eyelid to droop.

Causes

Up to 50 percent of people with xanthelasma have high “bad” cholesterol, leading researchers to link the two. Cholesterol is fats or lipids in the blood, a condition that is often hereditary.

However, a large portion of those with Xanthelasma have normal cholesterol, which points to other causes such as inflammation. 

Xanthelasma is the most common subtype of xanthoma, which are cholesterol deposits that can present in any part of the body. Researchers do not know if XP is related to changes in lipid metabolism.

When the levels of one or more of the lipoproteins that form from the binding of lipids and proteins are altered, it can result in dyslipidemia.

Primary hyperlipidemia can also cause Xanthomas. Primary hyperlipidemia is typically a genetic condition common in people with low levels of “good” cholesterol (high-density lipoproteins, or HDL) and high levels of “bad” cholesterol (low-density lipoproteins, or LDL). 

Risk Factors

Anyone can develop xanthelasma. However, you are at greater risk if you:

• Smoke
• Are overweight or obese
• Have high blood pressure
• Have diabetes
• Are a woman
• Are of Asian or Mediterranean descent
• Are between 30 and 50 years old
• Have chronic kidney disease
• Your lipid levels are abnormally high
• Are taking certain medications, including oral contraceptives, beta-blockers, anabolic steroids and retinoids

Diseases linked to xanthelasma include:

• Diabetes mellitus
• Inflammatory skin disorders
• Hypothyroidism
• Obesity
• Nephrotic syndrome (a type of kidney disease)
• Certain types of liver disease
• Systemic lupus erythematosus
• Erythroderma
• Allergic contact dermatitis

How Is Xanthelasma Diagnosed?

Doctors diagnose XP by examining the skin around the eyes. Your doctor may also order a series of lipid profiles to see if they are causing your symptoms. This will require the doctor to do a blood draw and send your blood to the lab for testing. This can also show if there is a potential health condition causing XP.

Treatment Options

In most cases, Xanthelasma is harmless. But the unsightly patches won’t go away on their own, and you may want them removed.

Doctors suggest a number of treatment options, including:

• Cryotherapy. This involves freezing the Xanthelasma with liquid nitrogen or other chemicals.
• Laser Surgery. Fractional C02, a type of laser technique, has been shown to be especially effective.
• Traditional Surgery. This involves using a knife to remove the Xanthelasma.
• Chemical Peels. A small study that used trichloroacetic acid (TCA) to treat Xanthelasma showed that 90% of the participants experienced satisfactory to excellent results.
• Radiofrequency Advanced Electrolysis (RAF). A study conducted in 2015 found this treatment to be effective in reducing and in some cases eliminating Xanthelasma with few recurrences.
• Medication. A study published in the British Journal of Ophthalmology suggests that the satin drug, simvastatin (Zocor), which is commonly used to treat cholesterol, can also be effective on Xanthelasma.

Although these treatments are effective, there can be side effects such as:

• Scars
• Changes in skin color
• Turned out eyelid

It is also important to note that the patches may recur, especially if you have inherited high cholesterol.

What Can You Do to Prevent Xanthelasma?

The first thing you can do is manage your cholesterol. For some people, changes in diet and lifestyle choices may be enough to manage cholesterol, including:

• Avoiding smoking and limiting alcohol consumption
• Maintaining a healthy weight
• Exercising at least 30 minutes at least four days a week
• Limiting consumption of saturated fats found in things such as butter, fried foods and fatty meats
• Taking cholesterol-lowering medication under the guidance of your doctor

Overall, these steps not only can help prevent Xanthelasma but also improve your general health.

When to See a Doctor

Xanthelasma could be an early warning sign that cholesterol has started to build up in your blood vessels.

If the cholesterol buildup is left unattended over time, it can form hard, sticky gunk called plaque in your arteries. This buildup (atherosclerosis) can lead to heart disease, heart attack or stroke.

The yellowing patches may also be linked to other heart diseases such as:

• High blood pressure
• Diabetes
• Smoking
• Obesity

FAQs

What is the cause of xanthelasma?

Up to 50 percent of people with xanthelasma have high levels of cholesterol, which could show a link between the two. However, it should also be noted that a significant portion of those with xanthelasma have normal cholesterol levels, which could point to other causes such as inflammation. 

Can xanthelasma go away on its own?

No. Xanthelasma do not go away on their own. In fact, they tend to stay the same size or grow larger with time. Some also combine to form even larger patches.

There are numerous treatment options you could use to get rid of xanthelasma, including cryotherapy, surgery, chemical peels and medication.

How do you get rid of xanthelasma naturally?

The best way to get rid of xanthelasma is under the guidance of your doctor and making changes in diet and lifestyle to lower cholesterol levels. 

References

1. What is xanthelasma? (May 2021). American Academy of Ophthalmology.

2. Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study. (September 2011). British Medical Journal.

3. Inflammation. (October 2020). American Academy of Ophthalmology.

4. XANTHELASMA. (June 2019). American Osteopathic College of Dermatology.

5. Fractional CO2 laser is an effective therapeutic modality for xanthelasma palpebrarum: a randomized clinical trial. (December 2014). Department of Dermatology, Kasr El Aini Hospital, Cairo University, Cairo, Egypt.

6. Treatment of eyelid xanthelasma with 70% trichloroacetic acid. (August 2009). Department of Ophthalmology, Santa Casa de São Paulo, São Paulo, Brazil.

7. Disappearance of eyelid xanthelasma following oral simvastatin (Zocor). (May 2005). British Journal of Ophthalmology.

8. Astragalus. (August 2020). National Center for Complementary and Integrative Health.

9. Hawthorn. (August 2020). National Center for Complementary and Integrative Health.

10. Flaxseed and Flaxseed Oil. (August 2020). National Center for Complementary and Integrative Health.

11. Red Yeast Rice. (August 2020). National Center for Complementary and Integrative Health.

12. Garlic. (August 2020). National Center for Complementary and Integrative Health.