Xanthelesama
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Xanthelasma (or xanthelasma palpebrarum) is a sharply demarcated yellowish collection of cholesterol underneath the skin, usually on or around the eyelids.
What is it?
Xanthelasma (or xanthelasma palpebrarum) is a sharply demarcated yellowish collection of cholesterol underneath the skin, usually on or around the eyelids. Although not harmful or painful, these minor growths could be disfiguring and can be removed. They are common in people of Asian origin and those from the Mediterranean region.
Because of the hereditary component, they could or could not indicate high blood levels of cholesterol. Where there is no family history of xanthelasmata, they usually indicate high cholesterol and could correlate with a risk of atheromatous disease.
Our eyelids can be affected by a variety of different clinical conditions. One such condition is called xanthalasma. Here we shall take a look at this condition in a bit more detail.
What is Xanthalasma?
Xanthalasma (Greek – ‘xanthos’ = yellow, ‘elasma’ = metal plate) is characterised by the presence of small yellow plaques that are more often visible on the upper eyelid when compared to the lower eyelid. The most common site of these yellow plaques is the inner aspect of the eyelid, sometimes referred to as the inner or medial canthus.
Who gets them?
Although most patients have a normal lipid level, more than 30% do show an lipid abnormality. Serum cholesterol could b elevated.
Xanthelasmas usually occur in middle-aged and elderly patients. They appear more often in females.
General appearance
Other than the characteristic yellow colour, the lesions can be hard i.e. calcareous or soft. In the initial stages, they tend to be symmetrical with all four eyelids being involved. However, over time they could join together and become larger lesions, making it look asymmetrical.
Causes
Xanthalasma seems to bear a close relationship to high levels of lipids in the blood. In particular, they are related to the change in the structure of proteins that carry fats in the blood i.e. lipoproteins. In adds to, they are seen in certain genetic conditions such as type II and type IV hyperlipidaemia.
Clinical features
As has been described above, the lesions in xanthalasma are typically yellowish plaques that are seen on the inner aspect of the upper eyelids. They rarely cause any significant symptoms but in some cases they could cause drooping of the eyelids, also called ptosis.
Where do they Occur?
The lesions occur near the inner upper eyelids. They are slightly elevated, yellowish, and have sharp borders.
Are they dangerous?
They usually do not cause patients discomfort, but can cause a significant cosmetic blemish.
They are not malignant
Diagnosis
The characteristic appearance makes diagnosis is fairly simple to just clinical examination. Patients could undergo additional tests to check their blood cholesterol and lipid levels. If required, a biopsy could be performed for further analysis and all this will show is the presence of certain cells called histiocytes that have within them deposition of fat.
Treatment
By themselves, xanthalasma often do not cause any problems. If blood lipid levels are high, it could require treatment. If the lesions are large and are causing problems with droopy eyelids, then in some cases, surgical treatment could be offered. Additional specialist treatments such as laser ablative treatment are also available along with cryotherapy and cauterisation using chemicals.
Treatment
Treatment consists of skin excision of the lesion. An alternative treatment could be the application of 75% trichloroacetic acid topically. Recurrence can occur with either method of treatment.
Prognosis
Despite the availability of surgical treatments, xanthalasma can recur in 4 out of 10 patients.
