Xanthelasma (xanthelasma palpebrarum) is a raised, yellow, soft, plaque-like, velvety lesion most commonly seen in the medial canthal (inner junction between upper and lower eyelid) area of the eyelid. It is a common subcutaneous eyelid lesion. It tends to be bilateral and is more common in the elderly. It has slightly more female preponderance. Xanthelasma is known to occur as a result of hyperlipidaemia, hypercholesterolemia, obesity and cardiovascular diseases. Although some patients with xanthelasma have normal lipid levels, others may show hyperlipidaemia (usually type II) or secondary hyperlipidaemia owing to conditions such as biliary cirrhosis or diabetes mellitus.
When it is large and nodular, it may assume tumourous proportions and is then called xanthoma. Tuberous xanthoma appears as solitary or multiple, placoid or papular lesion which has predilection for elbows, knees, fingers and buttocks. Multiple eruptive xanthomas may sometimes occur in patients.
Erasmus Wilson originally described xanthelasma about hundred years ago. This word is derived from the Greek Xanthos meaning ‘yellow’ and elasma, meaning ‘beaten metal plate’. Rarely these may be large enough to obstruct vision.
References
Yanoff Myron, Duker Jay S. Ophthalmology Third Edition. Mosby Elsevier 2009. P 1429.
Lee WR. Ophthalmic Histopathology. Springer-Verlag London 1993. P 218.
http://emedicine.medscape.com/article/1213423-overview
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4999105/
Garrison FH. An Introduction to the History of Medicine. Philadelphia: WB Saunders 1929. P 629.
Patients present with Xanthelasma on the lids thereby disfiguring the face.
Xanthelasma appear as one or more, flat or minimally elevated, placoid, yellowish lesions, affecting skin of eyelids, more commonly on the medial aspect of the lids. It is often bilateral and symmetrical. Sometimes, xanthelasmas coalesce and form raised, large nodular or plaque like lesions.
Elevated and nodular xanthelasma present as tuberous xanthoma.
The aetiology of xanthelasma is not known.
Xanthelasma was considered previously to be a degenerative condition, which involved the subcutaneous and muscular tissue. Now, most agree that this condition occurs as an isolated disorder. Few patients give a family history of xanthelasma.
Xanthelasma may occur as a result of
Pathogenesis
Xanthelasma develops as circumscribed deposits in the soft connective tissue of the eyelids. The deposits consist of histiocytes which contain cholesterol crystals and other lipids and are then turned into foam cells. The development begins in the peri-vascular spaces in the upper dermis.
Diagnosis is usually clinical.
Xanthelasma appear as one or more, flat or minimally elevated, placoid, yellowish lesions, affecting skin of eyelids, more commonly on the medial aspect of the lids. These sometimes occur unilaterally, but are present usually symmetrically on both sides. It is rarely associated with hyperkeratosis and cysts (xanthelasma cysticum). The concomitant presence of xanthelasma cysticum and hyper-pigmentation of the eyelids is described as Hutchinson’s syndrome.
No secondary changes are reported.
Lipid biochemistry
Although xanthelasmas are commonly thought to be associated with hyperlipidaemia, many patients have normal plasma cholesterol levels. However, these patients may have abnormalities in lipoprotein patterns.
Differential diagnosis
Management should be carried out under medical supervision.
Patients are treated systemically for any rise in serum lipid levels with lipid-lowering agents. Sometimes, such systemic therapy alone brings about resolution of xanthelasma.
The management of xanthelasma is mainly surgical.
Small lesions are generally observed over time for any increase in size.
Surgical therapy
Surgical therapy is considered for larger or cosmetically unacceptable lesions. After excision, wound may be allowed to heal as such or it is stitched.
Laser treatment may also provide benefit in xanthelasma.
There is high rate of recurrence of disease.
