Xanthelasma palpebrarum - External and Internal Eye
Alerts and Notices
Synopsis
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.
Codes
ICD10CM:H02.60 – Xanthelasma of unspecified eye, unspecified eyelid
SNOMEDCT:
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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Therapy
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References
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Last Reviewed:05/17/2020
Last Updated:03/17/2022
Last Updated:03/17/2022
Patient Information for Xanthelasma palpebrarum - External and Internal Eye
Overview
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 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.Treatments
To confirm your diagnosis of xanthelasma, the doctor may want to perform a skin biopsy. The procedure involves:- Numbing the skin with an injectable anesthetic.
- 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.
- Having the skin sample examined under the microscope by a specially trained physician (dermatopathologist).
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)
References
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.
Xanthelasma palpebrarum - External and Internal Eye