Xanthelasma is a sharply demarcated yellowish deposit of

cholesterol Cholesterol is the principal sterol of all higher animals, distributed in body Tissue (biology), tissues, especially the brain and spinal cord, and in Animal fat, animal fats and oils. Cholesterol is biosynthesis, biosynthesized by all anima ...

underneath the skin. It usually occurs on or around the

eyelids An eyelid ( ) is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. "Palpebral" ...

(''xanthelasma palpebrarum'', abbreviated XP). While they are neither harmful to the skin nor

pain Pain is a distressing feeling often caused by intense or damaging Stimulus (physiology), stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sense, sensory and emotional experience associated with, or res ...

ful, these minor growths may be disfiguring and can be removed. There is a growing body of evidence for the association between xanthelasma deposits and blood

low-density lipoprotein Low-density lipoprotein (LDL) is one of the five major groups of lipoprotein that transport all fat molecules around the body in extracellular water. These groups, from least dense to most dense, are chylomicrons (aka ULDL by the overall density ...

levels and increased risk of

atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. This is a chronic inflammatory disease involving many different cell types and is driven by eleva ...

. A xanthelasma may be referred to as a

xanthoma A xanthoma (pl. xanthomas or xanthomata) (condition: xanthomatosis) is a deposition of yellowish cholesterol-rich material that can appear anywhere in the body in various disease states. They are cutaneous manifestations of lipidosis in which lip ...

when becoming larger and nodular, assuming tumorous proportions. Xanthelasma is often classified simply as a subtype of xanthoma.

Diagnosis

Xanthelasma in the form of XP can be diagnosed from clinical impression, although in some cases it may need to be distinguished (

differential diagnosis In healthcare, a differential diagnosis (DDx) is a method of analysis that distinguishes a particular disease or condition from others that present with similar clinical features. Differential diagnostic procedures are used by clinicians to di ...

) from other conditions, especially necrobiotic xanthogranuloma,

syringoma Syringomas are benign tumor, benign eccrine sweat gland, eccrine sweat duct tumors, typically found clustered on eyelids, although they may also be found in the armpits, abdomen, chest, neck, scalp, or groin area, including genitals, in a symmetri ...

, palpebral

sarcoidosis Sarcoidosis (; also known as Besnier–Boeck–Schaumann disease) is a disease involving abnormal collections of White blood cell, inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph n ...

sebaceous hyperplasia Sebaceous hyperplasia is a disorder of the sebaceous glands in which they become enlarged, producing flesh-colored or yellowish, shiny, often umbilicated bumps. Sebaceous hyperplasia, primarily affecting older patients in high-concentration areas l ...

Erdheim–Chester disease Erdheim–Chester disease (ECD) is an extremely rare disease classified as a non- Langerhans-cell histiocytic neoplasm. In 2016, the World Health Organization (WHO) defined ECD as a slow-growing blood cancer that may originate in the bone marrow o ...

, lipoid proteinosis ( Urbach–Wiethe disease), and the syndrome of adult-onset asthma and periocular xanthogranuloma (AAPOX). Differential diagnosis can be accomplished by surgical excision followed by microscopic examination by a

pathologist Pathology is the study of disease. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatme ...

(

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, an interventional radiologist, or an interventional cardiology, interventional cardiologist. The process involves the extraction of sampling (medicine), sample ...

to determine

histopathology Histopathology (compound of three Greek words: 'tissue', 'suffering', and '' -logia'' 'study of') is the microscopic examination of tissue in order to study the manifestations of disease. Specifically, in clinical medicine, histopatholog ...

). The typical clinical impression of XP is soft, yellowish

papule A papule is a small, well-defined bump in the skin lesion, skin. It may have a rounded, pointed or flat top, and may have a umbilication, dip. It can appear with a Peduncle (anatomy), stalk, be thread-like or look warty. It can be soft or firm a ...

s, plaques, or

nodule Nodule may refer to: * Nodule (geology), a small rock or mineral cluster * Manganese nodule, a metallic concretion found on the seafloor *Nodule (medicine), a small aggregation of cells *Root nodule Root nodules are found on the roots of plants, ...

s, symmetrically distributed on the

medial Medial may refer to: Mathematics * Medial magma, a mathematical identity in algebra Geometry * Medial axis, in geometry the set of all points having more than one closest point on an object's boundary * Medial graph, another graph that repr ...

side of the upper eyelids; sometimes the lower eyelids are affected as well.

Treatment

Xanthelasmata can be removed with a

trichloroacetic acid Trichloroacetic acid (TCA; TCAA; also known as trichloroethanoic acid) is an analogue of acetic acid in which the three hydrogen atoms of the methyl group have all been replaced by chlorine atoms. Salts and esters of trichloroacetic acid are cal ...

peel, surgery,

laser A laser is a device that emits light through a process of optical amplification based on the stimulated emission of electromagnetic radiation. The word ''laser'' originated as an acronym for light amplification by stimulated emission of radi ...

s or

cryotherapy Cryotherapy, sometimes known as cold therapy, is the local or general use of low temperatures in medical therapy. Cryotherapy can be used in many ways, including whole body exposure for therapeutic health benefits or may be used locally to treat ...

. Removal may cause, although uncommon, scarring and pigment changes.

Prognosis

Recurrence is common: 40% of patients with XP had recurrence after primary surgical excision, 60% after secondary excision, and 80% when all four eyelids were involved. A possible cause might be insufficiently deep excisions.

Epidemiology

Xanthelasma is a rare disorder in the general population, with a variable incidence of 0.56 to 1.5% in western developed countries. The age of onset ranges from 15 to 75, with a peak in the 4th to 5th decades of life. There also seems to be a greater prevalence in females, but this might be due to higher consciousness to cosmetic defects.

Etymology

The word is derived from Greek ''xanthós, ξανθός'' 'yellow' and ''élasma, έλασμα'', 'foil'. The plural is ''xanthelasmata''.

References

External links

{{Medical resources , DiseasesDB = 28519 , ICD10 = {{ICD10, H, 02, 6, h, 00 , ICD9 = {{ICD9, 374.51 , ICDO = , OMIM = , MedlinePlus = 001447 , eMedicineSubj = oph , eMedicineTopic = 610 , MeshID = Human appearance Skin conditions resulting from errors in metabolism Disorders of eyelid, lacrimal system and orbit