Xanthelasma


Xanthelasma is a sharply demarcated yellowish deposit of cholesterol underneath the skin. It usually occurs on or around the eyelids. While they are neither harmful to the skin nor painful, these minor growths may be disfiguring and can be removed. There is no high-quality evidence that xanthelasma deposits are related to blood low-density lipoprotein levels or increased risk of atherosclerosis.
A xanthelasma may be referred to as a xanthoma 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 from other conditions, especially necrobiotic xanthogranuloma, syringoma, palpebral sarcoidosis, sebaceous hyperplasia, Erdheim–Chester disease, lipoid proteinosis, and the syndrome of adult-onset asthma and periocular xanthogranuloma. Differential diagnosis can be accomplished by surgical excision followed by microscopic examination by a pathologist. The typical clinical impression of XP is soft, yellowish papules, plaques, or nodules, symmetrically distributed on the medial side of the upper eyelids; sometimes the lower eyelids are affected as well.

Treatment

Xanthelasmata can be removed with a trichloroacetic acid peel, surgery, lasers or cryotherapy. 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, 'yellow' and élasma, έλασμα, 'foil'. The plural is xanthelasmata.