What is Xanthelasma Palpebrarum?
Xanthelasma palpebrarum is a medical term that refers to a condition where yellowish, fatty deposits, often made up of cholesterol, form under your skin. These deposits usually appear as soft, semi-solid lumps on the inside part of your eyes, most commonly at the corners of both your upper and lower eyelids. This condition gets its name from two languages: “xanthelasma,” from ancient Greek words meaning “yellow plate,” and “palpebrarum,” a Latin term meaning ‘around the eyelid.’
This kind of lump, or xanthoma, often shows up on the eyelids due to the cholesterol in your skin, although it could affect other parts of your body as well. While not dangerous to health, xanthelasma palpebrarum is usually considered a cosmetic issue because of the way it looks.
Xanthomas can be linked to conditions like high levels of fat in your blood (hyperlipidemia), diabetes, and issues with your thyroid. About half of the adults with xanthelasma have abnormal levels of fat in their blood. These deposits are also common in people with inherited conditions like familial hypercholesterolemia and hyperapobetalipoproteinemia, which both cause abnormally high levels of cholesterol in your blood. Moreover, in children and young people, the presence of xanthelasma could indicate they have inherited one of these conditions.
Even though you usually don’t need medical treatment for xanthelasma, some people choose to remove them for cosmetic reasons. One way to manage this condition is by lowering your levels of fat in your blood. Treatment options can include surgical removal, laser therapy, and applying a special type of acid (topical trichloroacetic acid or TCA) to the lumps. However, it’s important to remember that these lumps often come back. Understanding the potential connection between xanthelasma and other underlying conditions can help to improve the general health condition of a patient and reduce risks associated with these conditions.
What Causes Xanthelasma Palpebrarum?
Xanthomas refer to collections of cholesterol-rich material that primarily appear under the skin, in tendons or flesh beneath the skin, but they can pop up anywhere in the body. Around half of the people who develop xanthelasma, a specific type of xanthoma, either have an intrinsic or extrinsic lipid disorder.
Lipid disorders are basically issues with how your body stores and uses fat.
Intrinsic lipid disorders include having type IIa and IIb or type IV hyperlipidemias, conditions involving high levels of fat in the blood, or low levels of high-density lipoprotein (HDL), often known as ‘good cholesterol’.
Extrinsic lipid disorders include conditions such as primary biliary cholangitis (PBC), a liver disease that causes increased levels of lipoprotein X, a significant cholesterol carrier in the blood. Other conditions include acquired hyperlipoproteinemia, which happens due to diseases like diabetes, hypothyroidism, and nephrotic syndrome, a kidney disorder. Certain treatments using retinoids and estrogens, as well as conditions like sarcoidosis, an inflammation issue, can also lead to xanthomas.
Risk Factors and Frequency for Xanthelasma Palpebrarum
Xanthelasma palpebrarum, a skin condition that can appear in adults, has a larger occurrence rate in women (1.1%) compared to men (0.3%). Although it can develop in anyone between 20 and 70 years old, it is most frequently seen in people aged 35 to 55. The condition mostly affects the inside part of the upper eyelid, the inside of the lower eyelid, and the outer corner of the eye. Typically, the skin lesions appear in a symmetrical pattern.
Signs and Symptoms of Xanthelasma Palpebrarum
Xanthelasma palpebrarum is a condition that involves a thorough assessment of the patient’s health history and a detailed physical examination. Patients usually report that the spot has grown slowly over time and is not painful. Doctors should ask about the patient’s personal and family history of high cholesterol levels and early heart disease.
Upon examination, these spots show up as soft, yellow bumps or patches mainly on the inner corner of the upper eyelid. Sometimes, they can also appear on the lower eyelid. These patches usually feel firm when touched and often have a symmetrical appearance. In most cases, there are multiple patches rather than just one. Interestingly, pressing on these patches does not squeeze out any fatty substance.
Testing for Xanthelasma Palpebrarum
If you have xanthelasma (a condition that causes yellowish growths on your eyelids), your doctor may want to run some tests. This is because xanthelasma is often linked to problems with the fats (lipids) in your blood. So, your doctor may order a series of tests called a serum lipid profile. These tests measure the amount of different types of fats in your blood.
Along with the serum lipid profile, your doctor may also want to check your liver function, thyroid function, and fasting blood sugar levels. If you have diabetes, your doctor may check your glycosylated hemoglobin level, which can tell them how well you have been managing your blood sugar levels over the past three months.
Often, individuals with xanthelasma have higher levels of certain fats (cholesterol and triglycerides) and lower levels of good cholesterol (HDL). It’s important to not eat or drink anything except water for 12 hours before these blood tests to make sure the results are accurate.
Another way your doctor may want to evaluate your xanthelasma is by using a special type of ultrasound called ultrasound biomicroscopy. This test can help your doctor see the depth and texture of the growths, which can help them decide the best way to treat them. Xanthelasma is graded on a scale of 1 to 4. The grades are:
Grade 1: The growth is only on your upper eyelid.
Grade 2: The growth is on your upper eyelid and also the area on the side of your nose (medial canthus area).
Grade 3: The growth is on the sides of both your upper and lower eyelids.
Grade 4: The growths are spread out, involving both the inner and outer areas of both your upper and lower eyelids.
Treatment Options for Xanthelasma Palpebrarum
Xanthelasma is a condition where yellowish patches occur on the skin, usually around the eyes. It’s often linked with high levels of cholesterol or other fats in your blood. While certain lifestyle changes and medications to lower cholesterol can help in treatment, they might not make a big difference in how the affected area looks.
Usually, xanthelasma doesn’t go away on its own and may remain the same or even grow larger over time. People typically seek medical help primarily due to the change in their appearance caused by these yellowish patches.
If you’re unhappy with how it looks, there are several treatments that can improve the cosmetic appearance of xanthelasma. These include surgically removing the patches, laser therapy, freezing the area (cryotherapy), applying a heated instrument to remove the patches (cautery), or using trichloroacetic acid to remove them. Yet, it’s important to know that these patches can often come back.
One popular treatment option is laser therapy, which causes minimal damage to the surrounding areas and lets you avoid surgery. The two most commonly used types of lasers for treating xanthelasma are the fractionated Erbium: YAG (Er: YAG) or fractionated CO2 lasers.
While machines that use radio waves (radiofrequency machines) are potentially cheaper alternatives, they are generally not as effective as other treatments and can be more expensive.
Laser therapy is a good option for treating patches that aren’t too deep (less than 100 micrometers in depth). If the patches are deeper (from 100 to 1000 micrometers), a chemical peel with trichloroacetic acid can be effective. For large patches that are very deep (more than 1 micrometer), doctors may recommend surgery.
In some cases, the surgical approach might include a procedure called blepharoplasty, which involves removing or changing the shape of the skin of the upper or lower eyelid. This procedure can also involve removing any folds around the eyes and repositioning the fatty tissue of the eyelids to help improve how your eyes look.
What else can Xanthelasma Palpebrarum be?
Xanthelasma palpebrarum is a skin condition that can look similar to necrobiotic xanthogranuloma (NXG) and syringomas, both of which show up as small, skin-colored spots around the eyes. However, there are some key differences that help distinguish xanthelasma palpebrarum:
- It often appears on both sides of the face
- The spots are usually found above the corner of the eyes closest to the nose
- The spots tend to be a yellowish color
NXG, unlike xanthelasma palpebrarum, usually shows up as lesions or bumps on the skin around the eyes and can be purplish, reddish-brown, or yellowish in color.
About 30% of people with a rare disease called Erdheim-Chester disease also have xanthelasma palpebrarum. That said, it’s worth noting that people with xanthelasma palpebrarum don’t usually have the same health problems related to the bones, heart, lungs, and kidneys as people with Erdheim-Chester disease do.
When diagnosing xanthelasma palpebrarum, doctors also consider other possible conditions such as:
- Sebaceous hyperplasia
- Juvenile xanthogranuloma
- Nodular basal cell carcinoma
- Adult-onset asthma and periocular xanthogranuloma (AAPOX)
- Palpebral sarcoidosis
- Lipoid proteinosis
- Necrobiotic xanthogranuloma
There are also reports of fake xanthogranulomas appearing after a certain type of eye surgery, where silicon oil is left under the skin. But if there’s any doubt about the diagnosis of xanthelasma palpebrarum, a skin biopsy can be done to confirm it.
What to expect with Xanthelasma Palpebrarum
Xanthelasma palpebrarum, a harmless skin condition, does not pose any risk of developing into cancer, and usually, the treatment is sought for appearance reasons only. Although it can return, less than half of the treated cases typically experience a recurrence. However, the recurrence rate can change, depending on the specific treatment used.
It’s important to note that after being treated a second time, the recurrence rate increases to roughly 60%. Deeper occurrences of this condition, specifically those over 1 µm deep, have a higher chance of returning.
In addition to treating the xanthelasma itself, it’s crucial to manage any underlying health conditions that could cause more lesions to form. These include conditions such as high cholesterol (hyperlipidemia), liver diseases, diabetes, and thyroid disorders.
Possible Complications When Diagnosed with Xanthelasma Palpebrarum
Xanthelasma, while not causing any direct health issues, can be seen as undesirable because of the changes they cause to a person’s appearance. The treatments for this condition may also lead to some difficulties. These include discomfort, skin redness, scarring, and changes in skin color. These potential side effects occur at a similar rate, no matter what type of treatment is used.
Treatments near the eyes, like surgery, can cause problems like changes to the eyelid’s positions, drooping of the eyelid, and on rare occasions, injuries to the actual eye. Other procedures like cryotherapy and chemical treatments can cause significant scarring and changes in skin tone.
An important thing to note is that these xanthomas often come alongside high levels of fats in the blood, which can increase the risk of heart issues. These could include heart attacks, heart diseases caused by a low supply of blood, severe hardening of the arteries, and outcomes that could potentially be fatal.
Common Side Effects and Complications:
- Discomfort
- Skin redness
- Scarring
- Changes in skin color
- Modifications to eyelid positions
- Eyelid drooping
- Eye injuries (rare)
- Severe scarring
- Changes in skin tone
- Increased risk of heart-related conditions
- Potentially fatal outcomes
Preventing Xanthelasma Palpebrarum
Xanthelasma palpebrarum is a medical condition where painless, yellowish bumps appear near the eyes or on the eyelids. This is the most common form of a condition called xanthoma, where cholesterol accumulates under the skin – this can actually happen anywhere in the body. Xanthelasma is seen more often in women than men and usually shows up in adults who are between 40 and 50 years old. Around half the people with this condition have higher levels of cholesterol, which can often be linked to a hereditary condition (familial hypercholesterolemia) or other health issues. High cholesterol increases the chances of heart attacks, strokes, peripheral vascular disease (when narrowed arteries reduce blood flow to your limbs), and even death. Additionally, Xanthelasma palpebrarum can be associated with other medical conditions, like an underactive thyroid (hypothyroidism) and diabetes.
Even though xanthelasma palpebrarum appears as painless bumps around the eyes or on the eyelids and usually feels firm to the touch, sometimes larger ones can cause discomfort. Importantly, xanthelasma doesn’t lead to cancer and doesn’t always need to be treated. However, these yellowish bumps can be a cosmetic issue for some people. Treating high cholesterol and managing linked conditions can potentially shrink the existing bumps and lower the risk of more appearing. Other treatment options include using lasers, surgically removing them, and using skin peels. However, it’s common for these bumps to come back after treatment. Possible complications from these treatments include pain, scarring, infection, changes in skin colour, eye injury and ectropion, which is when the lower eyelid turns outwards.
