OVERVIEW

What is xanthelasma?

Xanthelasma, also known as xanthelasma palpebrarum or eyelid xanthoma, is a benign eyelid lesion that often occurs bilaterally.

It typically appears on the inner corner of the upper eyelid as a flat or slightly raised yellow patch or nodule. It may be caused by abnormal lipid metabolism but can also occur without dyslipidemia.

Pathological examination reveals numerous lipid-laden foam cells in the dermis, with no malignant tendency.

Is xanthelasma common?

It is relatively uncommon but more frequently seen in middle-aged and elderly individuals, with a higher prevalence in women than in men. The incidence is approximately 1.1% in women and 0.3% in men.

Can xanthelasma become malignant?

Xanthelasma is a benign lesion and does not undergo malignant transformation.

How does xanthelasma differ from xanthomas in other parts of the body?

Xanthomas can also occur on the skin or mucous membranes of other body parts, such as the limbs, chest, abdomen, and buttocks, with more extensive involvement. Compared to patients with simple xanthelasma, those with xanthomas elsewhere are more likely to have dyslipidemia or metabolic disorders.

Pathological findings also differ slightly, showing not only foam cells but also multinucleated giant cells, inflammatory cells, and fibrosis.

SYMPTOMS

What do xanthelasma typically look like?

• Xanthelasma most commonly appear on the upper eyelids near the inner corners of both eyes. In rare cases, they may develop on a single eyelid, the lower eyelid, the center of the eyelid, or near the outer corners.

• They present as soft, flat or slightly raised, well-defined yellow plaques or nodules.

• Xanthelasma tend to persist long-term and may slowly enlarge or merge together.

Do xanthelasma cause any other effects?

Patients with xanthelasma usually do not experience abnormal sensations such as pain or itching, nor do they develop functional abnormalities of the eyelids or eyeballs. Therefore, the impact of xanthelasma is limited to appearance. Patients typically seek medical help for cosmetic reasons.

CAUSES

Why do xanthelasmas grow?

• Current research suggests that xanthelasmas are related to abnormal lipid metabolism. About half of xanthelasma patients exhibit abnormal blood lipid levels or metabolic disorders, such as hyperlipidemia, diabetes, thyroid diseases, liver diseases, or low high-density lipoprotein (HDL) levels. However, xanthelasmas can also occur in patients without lipid abnormalities or other diseases, and the cause remains unknown.

• Certain medications, such as glucocorticoids, cyclosporine, and estrogen, may be associated with the development of xanthelasmas.

• Some xanthelasmas may appear following inflammatory skin conditions, such as exfoliative dermatitis or contact dermatitis.

DIAGNOSIS

Can xanthelasma be diagnosed based on appearance alone?

Clinical diagnosis can be made based on the characteristic appearance of xanthelasma. For patients with typical presentations, clinical diagnosis is usually sufficient to guide further treatment.

If a definitive diagnosis is required, a biopsy of the lesion for histopathological examination is necessary. Pathological examination reveals numerous lipid-laden foam cells in the dermis, surrounding blood vessels and dermal appendages, without inflammatory cell infiltration or fibrosis. Assessing whether the lesion involves the deep dermis or muscle layer can guide treatment selection.

Is it necessary to screen for dyslipidemia or other diseases with xanthelasma?

Screening for dyslipidemia or metabolic disorders plays a significant role in diagnosing xanthelasma and guiding treatment.

Given the association between xanthelasma and lipid abnormalities, as well as its status as an independent risk factor for ischemic heart disease, screening for these conditions helps identify potential underlying disorders and guides dietary or further medical management.

Therefore, screening for related conditions is recommended. Common findings include elevated cholesterol or triglyceride levels and reduced high-density lipoprotein levels.

TREATMENT

Which department should I visit for xanthelasma?

Ophthalmology, dermatology, medical cosmetology, and plastic surgery departments all offer treatments for this condition.

Diagnosing xanthelasma is not difficult. However, when it comes to treatment options, since methods like laser or cryotherapy require specific equipment, the choice depends on the available treatments in the department. If necessary, the doctor may recommend a referral.

Can xanthelasma improve after controlling blood lipids or metabolic diseases?

If poorly controlled dyslipidemia or metabolic diseases are present, internal medicine treatment should be prioritized. With dietary control or medical treatment, mild xanthelasma may improve, but it can also persist or worsen.

If no related conditions like dyslipidemia are present, improvement in xanthelasma is unlikely.

Are topical or oral medications effective for treating xanthelasma?

No.

Some medications are only effective when injected directly into the lesion.

What are the effective treatments for xanthelasma?

Xanthelasma typically does not affect eyelid function or vision, so the primary goal of treatment is cosmetic improvement. If there is no tendency for self-resolution and the condition affects appearance, treatments include surgical excision, laser, radiofrequency, cryotherapy, or local drug injection.

When can conservative or laser treatment be used for xanthelasma? When is surgery recommended?

The decision depends on the severity, extent of the lesion, and patient preference. Generally, for small, superficial lesions with mild elevation (height ≤ 5 mm), soft texture, and short duration (≤ 1 year), laser, radiofrequency, cryotherapy, or local drug injection may be attempted.

For cases opposite to the above, surgical excision is preferred. For larger or deeper lesions, surgery may involve not only removal but also flap reconstruction or orbicularis muscle repair to avoid complications like incomplete eyelid closure or ectropion.

Both surgical and non-surgical treatments have pros and cons, and patient preference is important, so a doctor's comprehensive assessment is necessary.

Can xanthelasma recur?

Xanthelasma is closely related to lifestyle and dietary habits, so the recurrence rate is high.

Patients with underlying conditions like dyslipidemia, larger initial lesions, or previous recurrences are more likely to experience recurrence.

DIET & LIFESTYLE

What should patients with xanthelasma pay attention to in daily life?

Patients already accompanied by dyslipidemia or metabolic diseases need to focus on control in daily life, including but not limited to the following key points:

• Reduce the proportion of carbohydrates and saturated fats in the diet, replacing the reduced portions with vegetables, fruits, grains, potatoes, legumes, and unsaturated fats.

• Change cooking habits that rely heavily on oil, salt, sugar, or strong flavors. Opt for steaming, boiling, stewing, or mixing methods instead, reduce frying, and cut back on the amount of oil used in stir-frying.

• Gradually increase daily physical activity based on individual conditions and maintain long-term exercise habits.

• Quit smoking and alcohol.

PREVENTION

How to prevent the occurrence or recurrence of xanthelasma?

Patients with hyperlipidemia or other metabolic diseases should control their condition under the guidance of a physician and avoid discontinuing medication arbitrarily. Pay attention to changes in diet and lifestyle habits; refer to the "Lifestyle" section for details.

The cause of xanthelasma in patients without abnormal blood lipids or other diseases remains unknown. Therefore, there are currently no effective preventive measures for this group of patients.