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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
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.
- 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
here for an example image of this condition
- 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.
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.
M et al. Xanthelasmata, arcus corneae, and ischaemic vascular disease and
death in general population: prospective cohort study.BMJ. 2011 Sep 15;343
Last reviewed 02/2021