Xanthelasma are Benign but
are Cosmetically Unattractive
Xanthelasma are deposits of cholesterol and lipids under the skin’s surface in the eyelid area characterized by yellowish-brown distinct areas that are soft and flat and elliptical in shape. A xanthelasma usually ranges in size from 5-30 mm in length. The lesions are symmetrical and bilateral (around both eyes) and tend to increase in number and size. Xanthelasma are permanent and are benign lesions that usually have no symptoms but are cosmetically unappealing. They typically appear after the age of 40 but are sometimes apparent even in teenagers. They usually occur in the inner canthus area (on the eyelids, upper and lower, nearest the nose).
The yellowish plaques represent lipids and cholesterol under the skin. These may be hereditary but in about 50-60% of patients there is high cholesterol and/or other lipids such as triglycerides.
Prevalence of Xanthelasma
Xanthelasma are somewhat rare, occurring in only 0.50% to 1.5% of the U.S. population and occur in women at almost twice the rate of men.
Xanthelasma are the most common type of xanthoma and histologically are the same as xanthomas in other parts of the body.
Treatment for Xanthelasma
Because a xanthelasma itself causes no symptoms and is not serious many patients choose no treatment.
However, because at least half of patients with xanthelasma have high plasma levels of lipids and cholesterol testing should be performed and treatment initiated if high cholesterol or triglycerides are discovered. Unfortunately, reducing the blood levels of lipids will not make the xanthelasma go away.
Many patients choose to have the xanthelasma removed for improved cosmetic appearance. Available treatments to remove xanthelasma include chemical (trichloroacetic acid) treatment, freezing with liquid nitrogen (cryotherapy), surgical removal and pulsed CO2 or argon laser treatment to remove the xanthelasma. Some xanthelasma recur after removal. Pulsed CO2 laser removal offers accuracy and removes the lesion with little or no scarring and little or no pigmentation effect, both which occur at higher rates with other forms of removal.