Xanthelasma is a harmless yellow skin lesion that often appears on or near the eyelids. They can appear flat or be small bumps. They manifest as a result of a buildup of subcutaneous cholesterol deposits. They are harmless but they can be an indicator of cardiovascular disease. Even though the exact cause of xanthelasma is not fully understood, it is linked to the buildup of fibroproliferative connective tissue and lipid-filled histiocytes called foam cells.

The vast majority of skin xanthomas (cholesterol deposits) are xanthelasmas. However, xanthelasmas affect only approximately 1% of the population. This skin disease occurs mostly in individuals between the ages of 20 and 70 and one-half of those affected will also have excessive cholesterol.

Being overweight or being a woman are both significant risk factors for xanthelasma. Other risk factors include regular smoking, diabetes, hypertension, and a family history of high cholesterol or xanthelasma.

Xanthelasma palpebrarum (XP) is the most common skin symptom. Most of the time, they look like soft, symmetrical, bilateral, yellow, thin, polygonal papules and plaques around the eyes. 

They can also appear on the neck, trunk, shoulders, and axillae.

It is possible to diagnose xanthelasma simply by examining the skin around the patient’s eyes. Doctors may request a blood test to see how high the cholesterol is in a patient’s blood. This can show if the xanthelasma is caused by a possible health problem, especially of a cardiovascular origin.

Further, some doctors also order the following tests to rule out other potential causes:

• Thyroid function test to identify if there is a thyroid disorder;
• Diabetes mellitus type II tests;
• Liver panel to determine if liver disease is present.

Treatment

Even though xanthelasma poses no health risks, some patients can still opt to have them removed. The following are some ways to remove xanthelasmas:

• Surgical procedures that involve extremely low temperatures called cryotherapy
• Surgery using laser beams
• Conventional skin removal and repair surgery 
• Heat surgery using an electric needle
• Chemical Peels

In most cases, xanthelasma can be treated and cured, but there may be unintended consequences such as scarring and changes in skin color. Also, xanthelasma can regrow even after surgical removal.

Taking control of cholesterol with a combination of food, exercise, and medication is important. This can help prevent xanthelasma from developing and enhance general health. A person can reduce his cholesterol levels by following these guidelines:

• Saturated fats (butter, fried foods, and fatty meats) should be limited or eliminated from the diet.
• Make exercise a habit – 30 minutes of vigorous walking daily is already sufficient
• Quit smoking
• Drink less alcohol or only occasionally

References

Laftah, Z., & Al-Niaimi, F. (2018). Xanthelasma: An Update on Treatment Modalities. Journal of cutaneous and aesthetic surgery, 11(1), 1–6. https://doi.org/10.4103/JCAS.JCAS_56_17

Cleveland Clinic (2022). Xanthelasma. Retrieved December 27, 2022, from https://my.clevelandclinic.org/health/diseases/23385-xanthelasma

American Academy of Ophthalmology (2022). Xanthelasma. Retrieved December 27, 2022, from https://www.aao.org/eye-health/diseases/what-is-xanthelasma