What Is Xanthelasma

Xanthelasma, or xanthelasma palpebrarum (XP), is a rare, thin, yellow growth that occurs due to the accumulation of fatty, lipid, and cholesterol deposits around the eyes or corner of the eyelids. It can often be an indicator of other health conditions, including diabetes, hyperlipidemia, and thyroid problems. 

This article will delve into the comprehensive examination of xanthelasma, covering its’ malignancy status,’ risk factors, prevention strategies, diagnosis, current treatment options, and other pertinent aspects.

Introduction 

Xanthelasma, or xanthelasma palpebrarum (XP), is a yellow growth or lump that typically presents around the periorbital areas (eyes or corner of the eyelids).¹ Although less common, it may also appear on the neck, trunk, shoulders, and axillae(armpits). 

Despite being a growth or mass, xanthelasma is fortunately non-cancerous (benign), meaning that it is harmless and does not spread elsewhere in the body.¹ However, if left untreated, it can grow bigger in size, causing discomfort. A xanthelasma also does not go away on its own² and cannot be popped like a pimple; it can only be removed via treatment alone. The main current treatment options for xanthelasma will be discussed below. 

Although harmless, xanthelasma can be a warning sign² of other health conditions such as: 

• Diabetes
• Hyperlipidemia (high cholesterol)
• Thyroid issues e.g. hypothyroidism 

Having xanthelasma can also increase the risk² of developing heart problems in the future, including:

• Heart disease
• Heart attack
• Atherosclerosis: thickening of arteries due to accumulation of fatty plaque deposits 

Xanthelasma is rare, with a prevalence estimated at only 4% worldwide.¹ However, it is the most common type of xanthoma.² Xanthomas are a group of skin lesions caused by lipid or cholesterol deposits around the eyes or corner of the eyelids. 

Causes

According to recent research studies, xanthelasma is caused by the build-up of lipids or cholesterol (hyperlipidemia) around the eyes or corner of the eyelids.¹ 

Many factors can cause hyperlipidemia and, eventually, xanthelasma including:^1,2 

• Genetic mutations in certain receptors or enzymes important in lipid metabolism 

• Certain conditions, such as:
  • Diabetes mellitus 
  • Thyroid problems: e.g. hypothyroidism 
  • Nephrotic syndrome

• Pregnancy
• Obesity or weight gain
• Excessive alcohol intake
• Inflammation 
• Certain medications: such as:
  • Oestrogen 
  • Tamoxifen 
  • Prednisolone 
  • Oral retinoids 
  • Cyclosporine 
  • Protease inhibitors

Risk factors 

Certain risk factors increase the risk of developing xanthelasma including:^1,2

• Sex: research suggests that women (1.1%) are more likely to develop xanthelasma than men (0.3%)¹
• Age: although xanthelasma can affect anyone between the ages of 15 to 73 years old, xanthelasma has been demonstrated to affect more people between the ages of 35 and 55 years old
• Excess weight: overweight or obesity
• History of smoking and/or alcohol abuse
• Family history of xanthelasma and/or high cholesterol
• Certain conditions: such as:
  • Diabetes
  • High blood pressure

Signs and symptoms

Xanthelasma is usually asymptomatic,² however, upon inspection, xanthelasmas appear as yellow, lipid deposits around the eyes or corner of the eyelids with the following signs and characteristics:^1,2 

• Flat (plaques) or bumpy (papules)
• Soft or firm
• Symmetrical 
• Bilateral (on both sides of the eyes)
• Thin 
• Discomfort 

Diagnosis

Although no tests are required to diagnose xanthelasma, a healthcare provider may order the following tests to be performed to provide a diagnosis² for a suspected patient: 

1. Physical examination: the healthcare provider will examine the skin around the patient’s eyelids. The patient may have one, or more than one xanthelasma.
2. Blood test: the healthcare provider may order a blood test to be performed to check the levels of the following:
   • Cholesterol: to determine whether the patient has high cholesterol 
   • Thyroid: to determine whether the patient has thyroid issues e.g. hypothyroidism 
   • Blood sugar: to determine whether the patient has diabetes 
   • Liver: to determine whether the patient has liver disease 
3. If any, some, or all of the above markers in the blood test are found to be abnormal, they can be an indicator of xanthelasma. 

Management and treatment options 

As discussed above, the only way to get rid of xanthelasma is via treatment. The main current management and treatment options for xanthelasma as demonstrated in recent research studies include:¹

• Surgery (or ‘’surgical excision’’): often involves using extreme heat and/or small knives to remove xanthelasmas.
• Laser surgery (or ‘’laser ablation’’), e.g carbon dioxide (CO₂) laser therapy, has been demonstrated to be the ‘’gold-standard’’ laser treatment for xanthelasmas.
• Topical chemical peels ,e.g. trichloroacetic acid (TCA). Research studies suggest that TCA at 70% concentration has the highest clinical efficacy and tolerability, requiring the least number of sessions to remove xanthelasmas. 
• Liquid nitrogen cryotherapy: used to freeze xanthelasma skin lesions. It is considered to be the primary ‘’first-choice’’ treatment for xanthelasma.
• Antibiotics,e.g. pingyangmycin, which has an anti-tumour effect. 
• Radio-frequency ablation: used to remove xanthelasmas followed by stitching afterwards.

Although successful in removing xanthelasmas, xanthelasmas have a high recurrence rate² (chance of coming back after removal), and therefore, these treatments may need to be performed more than once. Patients are also advised to maintain good cholesterol levels to further lower the recurrence rate of xanthelasmas. 

It is also worthy of noting that the above treatment options carry large side effects² including: 

• Pain
• Scars and/or blisters: particularly from liquid nitrogen cryotherapy 
• Oedema (intense swelling): particularly from liquid nitrogen cryotherapy 
• Changes to skin colour
• Changes to the structure of the eyelids: the eyelids may turn inside out 

Prevention strategies 

To prevent² and reduce the risk of developing xanthelasmas, people are advised to: 

• Maintain good cholesterol levels: if your cholesterol levels are high, consider implementing the following strategies:
  • Eat more fruit and vegetables
  • Cut down and limit your saturated fat intake. Saturated fat is often found in animal products such as full-fat dairy (e.g. butter) and red meat, as well as tropical oils (e.g. coconut oil), sweets, and baked goods (e.g. cakes). 
  • Engage in regular exercise and physical activity  
  • Take cholesterol-lowering drugs or ‘’statins.’’ 

• Avoid and/or stop smoking.
• Avoid and/or cut down on alcohol intake.
• Maintain a healthy weight: Lower your weight if overweight or obese. 
• Manage blood sugar: seek treatment if diabetic immediately. 
• Lower blood pressure 

Summary 

To conclude, Xanthelasma presents as a rare, benign and asymptomatic yellow plaque caused by lipid accumulation, predominantly cholesterol, around the eyes and eyelid corners. Despite its benign nature, the disease can signal underlying health issues such as diabetes, hyperlipidaemia and thyroid disorders. Various factors that contribute to elevated cholesterol levels also contribute to the likelihood of Xanthelasma, and its diagnosis involves physical examination and blood tests assessing cholesterol, blood sugar, liver and thyroid levels. While treatment options like surgery, chemical peels, freezing methods and radio-frequency ablation exist, it is crucial to note potential side effects associated with these interventions, such as oedema, scars, blisters, pain and discomfort.