xanthelasma

see also:

• hyperlipidaemia

• xanthelasma is a condition mainly of the peri-orbital region where cholesterol-rich deposits form under the skin of the eyelids forming yellowish lumps which are usually symmetrical and are especially prevalent on the inner canthus of the upper lids
• it results from perivascular infiltration of mono- and multinucleated foam cells within lipid-laden cytoplasmic vacuoles in the superficial reticular dermis
• age of onset ranges from 15 to 73 years, with a peak incidence between 30 and 50 years
• can be considered a risk factor for ischaemic heart disease, independent of other well-known cardiovascular risk factors (eg, hyperlipidaemia)
• rarely, very large deposits may cause madarosis (loss of eyebrows)

• xanthelasma palpebrarum (XP) is the most common cutaneous xanthoma
• prevalence of 1.1% in women and 0.3% in men

• ~50% have hyperlipidaemia
  • primary hyperlipidemias
    • types II and IV
    • having low high-density lipoprotein (HDL) levels
  • secondary hyperlipidemias, such as:
    • hypothyroidism
    • diabetes mellitus
    • drugs (glucocorticoids, cyclosporine, cimetidine, oestrogens, some antihypertensive medications, retinoids, certain antiepileptic drugs, anabolic steroids, tamoxifen, etc.),
    • food (diets rich in saturated fats, cholesterol, and alcohol)
    • primary biliary cirrhosis
• those with normolipidaemic persons:
  • low HDL levels
  • erythroderma
  • inflammatory skin disorders
  • allergic contact dermatitis

• necrobiotic xanthogranuloma
• syringomas
• adult-onset asthma and periocular xanthogranuloma (AAPOX)
• palpebral sarcoidosis
• sebaceous hyperplasia
• Erdheim–Chester disease – a systemic xanthogranulomatous disorder (lesions are indurated)
• lipoid proteinosis (lesions appear as a string of nodules along the lid margin, plus other mucocutaneous involvement is present)
• retinal surgery with silicone oil in tissue was reported to mimic xanthelasma – an entity termed a pseudo-xanthelasma

• fasting lipids
• fasting glucose, HbA1c
• LFTs
• TSH
• check medications
• if hyperlipidaemia is present then treat on its merits
• cosmetic Mx
  • various options including:
    • laser
    • radiofrequency - considered to be a easy, safe, quick, inexpensive, and effective treatment
    • trichloroacetic acid applied to the margins
    • cryosurgery
    • surgical excision
  • high recurrence rates esp. if hyperlipidaemia syndrome or in those with all four eyelids affected