Xanthelasma

Key Points
Condition results in soft, flat, velvety yellow lesions on the upper or lower eyelids.
Most frequent cause is poor lipid metabolism, usually as a result of genetic defect or underlying disorder such as diabetes mellitus, hypothyroidism, or nephrotic syndrome.
Most common type of xanthoma.
May be related to hyperlipidaemia.

Xanthelasma, occasionally referred to as Xanthelasma palpebrum, is the most common type of xanthoma. It results in soft, flat, velvety yellow lesions that often appear symmetrically on the upper or lower eyelids. These lesions are frequently caused by the accumulation of fat in macrophage immune cells in the skin, and more rarely, in the layer of fat under the skin. This is often the result of a disturbance in lipid metabolism, usually as a result of some genetic defect or underlying systemic disorder, such as diabetes mellitus, hypothyroidism, or nephrotic syndrome. These diseases can cause elevated levels of lipids and lipoproteins, which manifest as xanthomas. The lesions start off as a small bump and gradually grow larger over several months. The lesions may also be the result of hyperlipidaemia.

Differential Diagnosis (Other conditions with similar appearance)
Amyloidosis

Diagnosis
Key Points
blood and urine tests to determine cause of disturbed lipoprotein levels.
identify contributing factors and establish appropriate therapy.

Blood and urine tests are necessary to determine the cause of disturbed lipoprotein levels. Since heart disease can be a risk due to elevated lipid levels, identifying contributing factors is important, so the patient can undergo appropriate therapy or lifestyle changes.

Treatment
the main aim is identifying and treating the lipid disorder.
treatment typically consists of dietary and lifestyle modifications, with or without medication.
* surgery or other destructive procedures can be used in cases where lipid disorder treatment does not resolve the situation.

The main aim of treatment for xanthomas, and thus xanthelasma, is identifying and treating the lipid disorder. Treatment of the lipid disorder reduces or resolves the Xanthomas in most cases. Treatment for hyperlipidaemia will assist in the reduction of risk of heart disease and pancreatitis. Dietary and lifestyle modifications with or without medication are used to treat lipid disorders.

Surgery or additional procedures can be used to remove xanthomas that do not clear up as a result of tending to the lipid disorder. Treatments can include, but are not limited to, topical tricholoracetic acid, electrodesiccation, laser vaporisations, and excision.