Xanthelasma

Xanthelasma are yellowish plaques that occur most commonly near the inner canthus of the eyelid, more often on the upper lid than the lower lid. Xanthelasma palpebrarum is the most common cutaneous xanthoma. Xanthelasma can be soft, semisolid, or calcareous.

Diagnosis

Diagnosis is usually straightforward due to the characteristic color and site. It occurs more often in women than men, with peak incidence in the fourth to fifth decades.

Differential Diagnosis

• Syringomas (small skin-colored papules on lower eyelids)
• Large milial cysts (white, spherical cysts)
• Xanthomas in other areas appear more orange-yellow

Associated Diseases

Xanthelasma may be linked to lipid metabolism disorders such as hyperlipidemia, but can also appear in individuals with normal lipid levels. Patients may have increased cardiovascular risk factors.

Management

Patients should have their fasting lipid levels checked and undergo cardiovascular risk assessment. Treatment options include:

• Surgical excision
• Chemical treatment
• Laser treatment
• Cryocautery

Lipid-lowering medication and diet modifications have limited effects.

Prognosis

Xanthelasma itself is harmless, but it may indicate underlying lipid abnormalities and cardiovascular risk factors.