Xanthelasma is a sharply demarcated yellowish deposit of cholesterol underneath the skin. It usually occurs on or around the eyelids (''xanthelasma palpebrarum'', abbreviated XP). While they are neither harmful to the skin nor painful, 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 levels and 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 (

differential diagnosis In healthcare, a differential diagnosis (abbreviated DDx) is a method of analysis of a patient's history and physical examination to arrive at the correct diagnosis. It involves distinguishing a particular disease or condition from others that p ...

) from other conditions, especially necrobiotic xanthogranuloma, syringoma, palpebral sarcoidosis,

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Erdheim–Chester disease Erdheim–Chester disease (ECD) is an extremely rare disease characterized by the abnormal multiplication of a specific type of white blood cells called histiocytes, or tissue macrophages (technically, this disease is termed a non- Langerhans-cel ...

, lipoid proteinosis (

Urbach–Wiethe disease Urbach–Wiethe disease is a very rare recessive genetic disorder, with approximately 400 reported cases since its discovery. It was first officially reported in 1929 by Erich Urbach and Camillo Wiethe, although cases may be recognized dating b ...

), 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 ( biopsy to determine

histopathology Histopathology (compound of three Greek words: ''histos'' "tissue", πάθος ''pathos'' "suffering", and -λογία '' -logia'' "study of") refers to the microscopic examination of tissue in order to study the manifestations of disease. Spe ...

). 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, 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