Xanthelesma



Xanthelasma are yellowish plaques that occur most commonly near the inner canthus of the eyelid, more often on the upper lid than the lower lid. Xanthelasma palpebrarum is the most common cutaneous xanthoma. Xanthelasma can be soft, semisolid, or calcareous. Frequently, they are symmetrical. The upper lids are more frequently involved than the lower lids. Often, 4 lids are involved. Xanthelasma have a tendency to progress, coalesce, and become permanent.

Diagnosis


This is usually not a problem, since colour and site are characteristic. They occur a little more often in women than in men and the peak incidence is in the fourth to fifth decades. Once the plaque is established, it tends to remain static in size or grow slowly; it does not regress. Generally, eyelid function remains unimpaired. Ptosis is rare.

Differential diagnosis


  1. Sometimes syringomas and milia may be misdiagnosed as xanthelasma.
  2. Syringomas are small papules on lower eyelids and are skin-coloured.
  3. Large milial cysts are white and spherical.
  4. Xanthomas in other areas may appear more orange-yellow.
  5. The list of differentials for lipid disorders also needs to be considered.


Associated diseases


  1. Xanthelasma may represent a localised skin condition without any systemic abnormalities of lipoprotein metabolism or may be associated with an increase in the cholesterol-rich beta-lipoproteins (LDLs)[2]. See separate Hyperlipidaemia article.
  2. Some patients exhibiting xanthelasma have normal lipid levels but this is less common in younger patients. Although these patients are not at increased risk of carotid atherosclerosis, they are more commonly found to have other risk factors for cardiovascular disease - eg, a higher BMI, waist circumference and LDL-C levels[3].


Management


  1. Patients should have their fasting lipid levels checked and those with hyperlipidaemia should have a formal cardiovascular risk assessment using appropriate charts, with measures for prevention of cardiovascular disease as indicated.
  2. The lesions can be left alone unless the patient wishes them removed for cosmetic reasons (not usually available on the NHS).
  3. Various options are available including surgical excision (with or without skin grafting for large lesions), chemical treatment, laser treatment and cryocautery[4]. Full-thickness skin grafting obtained via blepharoplasty is available[5]. Xanthelasmas may recur after any of these interventions.
  4. Lipid-lowering medication and diet modification have a limited (if any) effect on these lesions.


Prognosis


The condition itself is harmless. The prognosis depends on any association with underlying lipid abnormalities and cardiovascular risk.

Dr. Narendra Patwardhan, at Hair and Skin clinic, Bhandarkar Road, Pune is an expert Cosmetologist, Dermatologist, Skin Specialist and Hair Specialist and has expert knowledge and a great deal of expertise in Hair Transplants.