xanthelasma

Xanthelasma palpebrarum, commonly referred to simply as xanthelasma, are soft, yellow to orange plaques that appear on the skin of the eyelids, most often along the medial aspects near the inner canthi. They are typically bilateral, may be slightly raised, and can be cosmetically noticeable.

The plaques consist of lipid-laden macrophages within the dermis. The exact cause is not fully understood, but xanthelasma are associated with disturbances in lipid metabolism. They frequently occur in people with elevated cholesterol or triglyceride levels, including those with familial hyperlipidemia. They can also be seen in liver disease (such as primary biliary cholangitis), hypothyroidism, or diabetes, though lesions may occur without systemic lipid abnormalities.

Diagnosis is usually clinical, based on appearance. A lipid panel is often obtained to assess cardiovascular risk and underlying lipid disorders. If the diagnosis is uncertain, a skin biopsy can reveal foam cells in the dermis, but this is not routinely required. Differential diagnosis includes other eyelid lesions and eruptive xanthomas.

Treatment is generally for cosmetic reasons. Managing any underlying lipid disorder is advised, using lifestyle modification or medications (for example, statins or fibrates) as appropriate. Local removal options include laser therapy (such as CO2 laser), surgical excision, electrocautery, cryotherapy, or chemical cauterization with trichloroacetic acid. Recurrence after removal is common, and procedures may result in scarring or pigment changes. Xanthelasma are not malignant, but their presence can indicate an underlying lipid or metabolic condition requiring evaluation.