Xanthelasma

What xanthelasma is

Xanthelasma are the most common type of xanthoma, a skin deposit of fat-laden immune cells (foam cells). They look like:

• soft, velvety, yellow or orange patches
• flat or slightly raised
• usually on the upper eyelids near the nose, sometimes on the lower lids
• often on both sides, in a symmetrical pattern
• painless and not itchy

They tend to grow slowly and do not go away on their own.

Causes and the link to cholesterol

Xanthelasma form when cholesterol from the blood leaks into the skin and is taken up by immune cells. Associations include:

• high cholesterol and hyperlipidemia: found in about half of people with xanthelasma
• familial hypercholesterolemia: inherited very high LDL, especially if xanthelasma appear young or with tendon xanthomas
• primary biliary cholangitis and other cholestatic liver diseases
• hypothyroidism, diabetes and kidney disease (nephrotic syndrome), which raise blood fats
• medicines that raise cholesterol, such as some retinoids and steroids
• normal cholesterol: about half of people with xanthelasma have normal blood fat levels; local factors in eyelid skin may play a role

Heart disease risk

A large Danish population study found that people with xanthelasma had a higher risk of heart attack, atherosclerosis and death, independent of their cholesterol levels. Xanthelasma are therefore a useful prompt for a full cardiovascular risk check.

Diagnosis

Xanthelasma are usually diagnosed by their appearance. Recommended tests:

• lipid panel: total cholesterol, LDL, HDL, triglycerides
• blood sugar (HbA1c), thyroid function and liver function tests
• cardiovascular risk assessment: blood pressure, smoking history, family history
• biopsy only if the appearance is unusual, to rule out other eyelid growths

Treatment

Treat underlying blood fat abnormalities

Lifestyle changes and medicines such as statins lower cholesterol and heart risk. This may stop xanthelasma growing but rarely makes existing patches disappear.

Removal options

Removal is for cosmetic reasons. Treatments are performed by dermatologists, ophthalmologists or oculoplastic surgeons, because the eyelid skin is thin and close to the eye.

Xanthelasma recur in a substantial proportion of people after removal, more often if blood fats remain high or several eyelids are affected. Do not try to remove them at home with creams, acids or picking, which can damage the eyelid and eye.

Outlook

Xanthelasma are harmless in themselves but act as a visible marker of possible high cholesterol and increased heart risk. Checking and treating blood fats and other risk factors is the most important health step.

Frequently asked questions

What causes xanthelasma?

Xanthelasma form when cholesterol deposits in the skin of the eyelids. About half of people with them have high cholesterol or other blood fat abnormalities. Liver disease, diabetes, hypothyroidism and genetics can contribute, but some people have normal cholesterol.

Does xanthelasma mean high cholesterol?

Not always. About half of people with xanthelasma have abnormal blood fats. Because they are also linked to a higher risk of heart disease regardless of cholesterol, a lipid blood test and heart risk check are recommended.

Can xanthelasma go away on its own?

Rarely. Xanthelasma usually stay or slowly grow. Lowering cholesterol may stop new ones forming but does not usually shrink existing patches. They can be removed by surgery, laser, chemical peel or freezing.

How is xanthelasma removed?

Options include surgical excision, laser treatment, chemical peels with trichloroacetic acid, cryotherapy and radiofrequency ablation, performed by a specialist. Recurrence after removal is common.