Xanthelasma

Overview

Xanthelasma are soft, flat, yellowish patches of fatty (cholesterol-rich) material that form on or around the eyelids, most often near the inner corners. They are a type of xanthoma, which is a deposit of fat under the skin.

Xanthelasma themselves are harmless and not painful, but they can be a visible cosmetic concern and, in some people, a sign of high cholesterol or other lipid problems. Because of that possible link, finding xanthelasma is a reason to have blood fat (lipid) levels checked, even though many people with them have normal cholesterol.

Xanthelasma tend to develop slowly and may go unnoticed at first. They are most common in middle age and can affect one or both eyelids. While they do not threaten the eye or vision, many people choose to have them assessed because of their appearance and because of their possible link to cholesterol.

Symptoms

Xanthelasma are usually easy to recognize by appearance:

• Soft, flat or slightly raised yellow patches
• Located on or around the eyelids, often the inner corners near the nose
• Often symmetrical, appearing on both upper or both lower lids
• Painless and not itchy
• May slowly enlarge or multiply over time

They do not affect vision unless they become very large, but their presence may warrant a check of cholesterol levels.

The patches are usually soft to the touch and do not change with temperature or activity. Because they sit on the thin skin of the eyelids, they can be more noticeable than similar deposits elsewhere on the body.

Causes

Xanthelasma form when cholesterol-rich material is deposited in the skin of the eyelids. Contributing factors include:

• High cholesterol or abnormal lipids: Especially elevated LDL ("bad") cholesterol, though not everyone with xanthelasma has high cholesterol.
• Inherited lipid disorders: Conditions such as familial hypercholesterolemia.
• Other health conditions: Diabetes, liver disease, or an underactive thyroid can affect lipid levels.

In some people no underlying lipid problem is found, and the deposits occur on their own.

Doctors often check thyroid and liver function as well, since an underactive thyroid or liver problems can disturb the body's handling of fats and contribute to deposits like xanthelasma.

Risk Factors

• High cholesterol or other abnormal blood fats
• Family history of high cholesterol or xanthelasma
• Diabetes
• Liver disease or an underactive thyroid
• Middle age, with women affected somewhat more often

Diagnosis

Diagnosis is usually straightforward and based on appearance:

• Visual examination: A doctor can usually identify xanthelasma by their characteristic look and location.
• Blood lipid tests: Cholesterol and triglyceride testing to check for an underlying lipid problem.
• Additional tests: Sometimes checks for diabetes, thyroid, or liver issues if indicated.

If an inherited cholesterol disorder is suspected, especially in younger people or those with a strong family history, the doctor may recommend further testing and screening of close relatives.

Treatment

Xanthelasma are harmless, so treatment is optional and often for cosmetic reasons. Options include:

• Managing cholesterol: Diet changes, exercise, and cholesterol-lowering medicine if lipids are high; this does not always remove existing deposits but supports overall heart health.
• Surgical removal: Cutting away the deposit, often for larger lesions.
• Laser or chemical treatment: Lasers or carefully applied chemicals to remove the patches.
• Cryotherapy or radiofrequency: Freezing or heat-based methods.

Xanthelasma can return after removal, particularly if lipid levels remain high, so addressing cholesterol is part of long-term management.

Because removal can sometimes leave changes in skin color or a small scar, it is best done by an experienced clinician who can advise on the most suitable method for your skin. Combining removal with attention to cholesterol gives the best chance of a good cosmetic result and fewer new deposits over time.

Prevention

• Keep cholesterol and other blood fats in a healthy range
• Eat a balanced diet lower in saturated and trans fats
• Stay physically active and maintain a healthy weight
• Manage conditions such as diabetes and thyroid disease
• Have regular cholesterol checks if you are at risk

When to See a Doctor

See a doctor if you notice yellowish patches on your eyelids, both to confirm the diagnosis and to have your cholesterol checked. Also seek care if:

• The patches grow, multiply, or affect your vision
• You want them removed for cosmetic reasons
• You have other signs of high cholesterol or heart disease risk

Related Topics

Frequently Asked Questions

References

1. Mayo Clinic. High cholesterol.
2. MedlinePlus, U.S. National Library of Medicine. Xanthoma.
3. American Academy of Dermatology. Cholesterol deposits and the skin.
4. National Heart, Lung, and Blood Institute (NHLBI). Blood Cholesterol.