Xanthelasma are xanthoma that appear as yellowish plaques or nodules in the subcutaneous tissues in the periorbital region. They represent an accumulation of lipid-containing macrophages in the dermis. In about 50% of patients lipid levels are normal (1,2); although in young individuals with this condition there is a higher incidence of hypercholesterolaemia.
Treatment options include laser therapy, electrodessication followed by curettage, cautious application of trichloracetic acid using a cotton wool bud and excision (this latter option is rarely performed). Lipid levels should be checked in all patients presenting with xanthelasma.
There is no evidence that lipid lowering treatment has any impact on the appearance of xanthelasma.
Recurrences of xanthelasma often occur despite effective local treatment. It is not known whether lipid levels are involved in the rate of recurrence.
Notes:
- xanthelasma has been reported in the following erythroderma and inflammatory skin disorders in the presence of normal lipid profiles (4)
- the mechanism that initiates macrophage accumulation, cholesterol uptake and foam-cell formation in a normolipaemic patient following an inflammatory skin disorder is not yet been elucidated
- a mechanism that has been suggested is that increased plasma lipid peroxidation (derived from oxidized low-density lipoprotein) may lead to accumulation of cholesterol in macrophages and formation of foam cells (5)
- cardiovascular risk and presence of xanthelasma
- study evidence (6) suggests that xanthelasmata predict risk of myocardial infarction, ischaemic heart disease, severe atherosclerosis, and death in the general population, independently of well known cardiovascular risk factors, including plasma cholesterol and triglyceride concentrations
- in all age groups in both women and men, absolute 10 year risk of myocardial infarction, ischaemic heart disease, and death increased in the presence of xanthelasmata
- the highest absolute 10 year risks of ischaemic heart disease of 53% and 41% were found in men aged 70-79 years with and without xanthelasmata. Corresponding values in women were 35% and 27%
- in contrast, arcus corneae was not an important independent predictor of risk
Click here for an example image of this condition
Reference:
- Pulse (2003), 63 (9), 72.
- Horn T D, Mascaro J M, Mancini A J, Salasche S J, Saurat J-H, Stingl G, eds. Dermatology, 1st edition. NewYork, Mosby, 2003.
- Dermatol Surg Oncol (1987), 13, 149-51.
- Walker A E, Sneddon I B. Skin xanthelasma following erythroderma. Br J Dermatol 1968: 80: 580587.
- Bergman R, Kasif Y, Aviram M, et al. Normolipidaemic xanthelasma palpebrarum: lipid composition, cholesterol metabolism in monocyte-derived macrophages, and plasma lipid peroxidation. Acta Derm Venereol 1996: 76: 107110.
- Christoffersen M et al. Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study.BMJ. 2011 Sep 15;343