Xanthelasma is a sharply demarcated yellowish deposit of

cholesterol Cholesterol is any of a class of certain organic molecules called lipids. It is a sterol (or modified steroid), a type of lipid. Cholesterol is biosynthesized by all animal cells and is an essential structural component of animal cell memb ...

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. The human eye ...

(''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 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 densi ...

levels and increased risk of

atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis in which the wall of the artery develops abnormalities, called lesions. These lesions may lead to narrowing due to the buildup of atheromatous plaque. At onset there are usually no s ...

. 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 (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 Sarcoidosis (also known as ''Besnier-Boeck-Schaumann disease'') is a disease involving abnormal collections of inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph nodes. Less commonly af ...

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 on the face. Newly formed nodules often swell with sweating (which is pathognomonic for ...

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 ...

, 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 ...

), 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 the causes and effects of disease or injury. 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 th ...

(

biopsy A biopsy is a medical test commonly performed by a surgeon, interventional radiologist, or an interventional cardiologist. The process involves extraction of sample cells or tissues for examination to determine the presence or extent of a dise ...

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. Sp ...

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

papule A papule is a small, well-defined bump in the skin. It may have a rounded, pointed or flat top, and may have a dip. It can appear with a stalk, be thread-like or look warty. It can be soft or firm and its surface may be rough or smooth. Some h ...

s, 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 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 calle ...

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" is an acronym for "light amplification by stimulated emission of radiation". The ...

s or

cryotherapy Cryotherapy, sometimes known as cold therapy, is the local or general use of low temperatures in medical therapy. Cryotherapy may be used to treat a variety of tissue lesions. The most prominent use of the term refers to the surgical treatment, s ...

. 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