Xanthelasma

Keywords and Synonyms: plural is xanthelasmata

Overview
Xanthelasma (or xanthelasma palpebrarum) is a sharply demarcated yellowish collection of cholesterol underneath the skin, usually on or around the eyelids. The plural is "xanthelasmata". The root of the word is from Greek xanthos, ξανθος, "yellow".

Xanthelasma are distinct from xanthoma which are larger and nodular, lesions. Xanthelasma are sometimes classified as a subtype of xanthoma.

Epidemiology and Demographics
A study of 12,745 people from Denmark identified xanthelasmata in 4.4% of participants aged 20-93.

Natural History, Complications, Prognosis
The lesions themselves are not harmful or painful. They may, however, be a marker of underlying atherosclerosis.

Association with Atherosclerosis
In a prospective population based cohort study (The Copenhagen City Heart Study), a total of 12,745 participants who were free of ischemic heart disease and aged 20-93 years were followed for a mean of 22 years. The mulivariate adjusted risk (hazard/odds ratios adjusted for confounders including cholesterol and triglyceride concentrations) of an adverse outcome associated with the presence of xanthelasmata were as follows:


 * Myocardial infarction: 1.48 (95% confidence interval 1.23 to 1.79)
 * Ischemic stroke: 0.94 (0.73 to 1.21)
 * Death: 1.14 (1.04 to 1.26) for death.

Thus, independent of other cardiac risk factors, the presence of a xanthelasma appers to be an independent risk factor for atherosclerotic heart disease. In the same study, arcus senilis was not identified as an independent risk factor.

Differential Diagnosis of Associated Conditions

 * Diabetes
 * High cholesterol levels (specifically familial hypercholesterolemia)
 * LDL receptor deficiency
 * Menopause
 * Primary biliary cirrhosis
 * Vitamin E deficiency (familial isolated, autosomal recessive inheritance)

Treatment
These minor growths may be disfiguring and can be removed. Xanthelasmata can be removed with trichloroacetic acid peel, surgery, lasers or cryotherapy. Removal can cause scarring and pigment changes, but it is unusual after treatment with trichloroacetic acid.