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Xanthelasma palpebrarum - External and Internal Eye
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Xanthelasma palpebrarum - External and Internal Eye

Contributors: David O'Connell MD, Belinda Tan MD, PhD, Susan Burgin MD
Other Resources UpToDate PubMed


Xanthelasma palpebrarum (XP) is the most commonly encountered type of xanthoma and is classified as a type of localized plane xanthoma. It typically presents as yellowish macules or slightly elevated papules or plaques on the eyelids beginning in the fourth or fifth decade of life. XP involves the upper medial lids most prominently but may be more extensive, also involving the lower eyelids. The lesions are asymptomatic.

XP is approximately 3 times more common in women and does not appear to have any ethnic variation. Approximately half of patients with XP have a lipid disorder. While the majority of these cases occur in the setting of acquired hyperlipidemia, XP is also seen in the setting of type II hyperlipoproteinemia. XP has been shown to be an independent risk factor for atherosclerosis and, consequently, ischemic cardiovascular disease.


H02.60 – Xanthelasma of unspecified eye, unspecified eyelid

6400008 – Xanthoma of eyelid

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Differential Diagnosis & Pitfalls

  • Necrobiotic xanthogranuloma – Periorbital plaques are extensive and commonly involve the medial canthus. Extrafacial plaques have active erythematous borders and often have central atrophy or ulceration.
  • Generalized plane xanthomas – The face, neck, and trunk may be involved; may be associated with hyperlipidemia, paraproteinemia, myeloma, or other lymphoid malignancies.
  • Adult-onset asthma and periocular xanthogranuloma – A non-Langerhans cell histiocytosis with bilateral yellowish periorbital plaques and deeper nodules often with associated edematous appearance. Some cases have been associated with IgG4-related disease.
  • Erdheim-Chester disease – A non-Langerhans cell histiocytosis in which approximately 25% of patients will have xanthelasma-like lesions very similar to XP but usually more extensive laterally and not associated with the typical hyperlipoproteinemia seen in XP.
  • Syringoma – Confluence of smooth papules; less yellow than XP and tends to favor the lower lid area.
  • Palpebral sarcoid – Yellow-brown to purple papules and plaques progress to annular or circinate configurations, often with associated lid edema. See sarcoidosis.
  • Lipoid proteinosis – Beaded papules at the margins of the eyelids.
  • Basal cell carcinoma (BCC) – May occur on the eyelid or medial or lateral canthus. Usually solitary and typical BCC morphology.
  • Sebaceous hyperplasia
  • Other forms of localized plane xanthoma

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Last Reviewed:05/17/2020
Last Updated:03/17/2022
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Patient Information for Xanthelasma palpebrarum - External and Internal Eye
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Contributors: Medical staff writer


Xanthelasma (xanthelasma palpebrarum) is a skin condition that develops flat yellow growths on the eyelids.

Xanthelasma is often seen in people with high cholesterol or other fat (lipid) levels in the blood, and the lesions contain deposits that are high in fat (lipid-rich).

Who’s At Risk

Xanthelasma can occur in people of any race and of either sex. However, females seem to be more frequently affected than males. In addition, it is unusual for a child or teenager to develop xanthelasma; most individuals develop the condition in middle age.

Approximately one half of patients with xanthelasma have high amounts of fats (lipids) in their blood, such as high cholesterol or high triglycerides.

Signs & Symptoms

The most common locations for xanthelasma include:
  • One or both upper eyelids, especially near the nose
  • One or both lower eyelids
Xanthelasma appears as a yellow-to-orange patch or bump. Ranging in size from 2-30 mm, xanthelasma is flat-surfaced and has distinct borders (well-defined). Once present, xanthelasma does not usually go away on its own. In fact, lesions frequently grow larger and more numerous.

Xanthelasma is usually not itchy or tender. Individuals with xanthelasma are usually most concerned with their cosmetic appearance.

Self-Care Guidelines

See your doctor for any new skin growth to obtain a correct diagnosis.

When to Seek Medical Care

See a dermatologist or another physician if any new growth develops on your skin.


To confirm your diagnosis of xanthelasma, the doctor may want to perform a skin biopsy. The procedure involves:
  1. Numbing the skin with an injectable anesthetic.
  2. Sampling a small piece of skin by using a flexible razor blade, a scalpel, or a tiny cookie cutter (called a "punch biopsy"). If a punch biopsy is taken, a stitch (suture) or two may be placed and will need to be removed 6-14 days later.
  3. Having the skin sample examined under the microscope by a specially trained physician (dermatopathologist).
Once the diagnosis of xanthelasma is confirmed, the physician will likely check cholesterol levels in your blood (a lipid panel). If you have a lipid abnormality, exercise and dietary modifications will likely be recommended. Many people also require an oral medication to lower their lipids. Treatment of underlying lipid abnormalities does not cure every xanthelasma.

If the xanthelasma is cosmetically unappealing and if it does not respond to lipid-lowering therapies, treatments include:
  • Freezing with liquid nitrogen (cryotherapy)
  • Surgical excision
  • Laser treatment
  • Application of a specially formulated acetic acid solution to dissolve the xanthelasma
  • Electric needle treatment (electrodesiccation)
All of these treatment options may cause scarring, and they do not keep the xanthelasma from coming back or prevent new lesions from developing.


Bolognia, Jean L., ed. Dermatology, pp.1451. New York: Mosby, 2003.

Freedberg, Irwin M., ed. Fitzpatrick's Dermatology in General Medicine. 6th ed. pp.1467, 1472, 2541. New York: McGraw-Hill, 2003.
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Xanthelasma palpebrarum - External and Internal Eye
A medical illustration showing key findings of Xanthelasma palpebrarum : Eyelids, Hypercholesterolemia, Medial canthus, Smooth papules, Smooth plaques
Clinical image of Xanthelasma palpebrarum - imageId=236041. Click to open in gallery.  caption: 'Yellow and brownish papules coalescing to form plaques on and around the eyelids.'
Yellow and brownish papules coalescing to form plaques on and around the eyelids.
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