Definition

Xanthelasma is a yellowish plaque caused by lumps of fat that appear on the eyelids. This eyelid disorder often occurs in women aged 30-50 years, particularly in individuals with high cholesterol. These lumps of fat are generally harmless and do not cause pain or itchiness in the eyes. However, the main concern for people with xanthelasma is the appearance and discomfort around the eyes.

Causes

Xanthelasma is primarily caused by high cholesterol levels, also known as hyperlipidemia, where fats elevate in the blood due to impaired fat metabolism. Genetic or hereditary factors play a significant role in causing this disorder. Research indicates that fatty deposits in the eyes can start forming as early as 15 years old and can appear until the age of 73.

Risk Factor

Several conditions can increase the risk of developing xanthelasma, including:

• Female
• Age range of 30-50 years old
• Smoking habit
• Excessive alcohol consumption
• Overweight or obese
• A medical history of high blood pressure, diabetes, or high cholesterol levels

Symptoms

Xanthelasma is characterized by yellow lumps or plaques on the eyelids, typically at the inner corner of the eye. These plaques can appear on both the upper and lower eyelids, as well as in the right and left eyes. Over time, the lumps may form in one eye, then merge and become permanent, resembling a single butterfly wing.

The yellow bumps or plaques are usually not painful nor itchy. The bumps are also soft and vary in size. In rare cases, xanthelasma can indicate a potential heart disease.

Diagnosis

Diagnosis of xanthelasma involves examining the history of symptoms and a physical examination that helps examine the skin lesions. The doctor will inspect the skin around the eyes for lumps or plaques on the eyelids. They will also confirm and rule out other possible eye disorders.

Cholesterol levels will be assessed by blood tests to determine if the symptoms are related to high cholesterol levels.

Management

Xanthelasma is generally not dangerous and does not cause any vision issues. Treatment is not necessary if it does not cause discomfort. However, if xanthelasma becomes bothersome, several treatment options are available:

• Cryotherapy: Uses liquid nitrogen to freeze and easily remove xanthelasma.
• Surgical Removal: A scalpel is used to surgically remove xanthelasma.
• Laser Surgery: Surgical procedure utilizing laser to remove xanthelasma.
• Radiofrequency Advanced Electrolysis (RAF): Removes xanthelasma using radiation emissions. A 2015 study found this therapy effective with low recurrence rates.
• Chemical Peeling: Removes xanthelasma using a chemical solution.
• Medications: Treats high cholesterol to prevent the growth of xanthelasma. Medications require a doctor's examination and prescription.

Complications

While xanthelasma is harmless, it still indicates high cholesterol levels. Complications usually occur because of high cholesterol levels itself, such as formation of plaques in blood vessels, which can trigger heart disease and stroke. 

Aesthetic discomfort can also be a concern for xanthelasma patients. Additionally, the plaque may become painful, red, or form scar tissue if wounded.

Prevention

Preventing xanthelasma involves controlling cholesterol levels, the main trigger for the condition. Some steps that can be taken to prevent it include:

• Reducing alcohol consumption
• Quitting smoking
• Exercising regularly (at least 30 minutes a day)
• Eating more fiber (fruits, vegetables, whole grains, nuts)
• Consuming healthy fats, can be found in fish, nuts, and seeds
• Avoiding saturated fats (red meat, full cream dairy products, packaged foods)
• Maintaining an ideal body weight

For people with high cholesterol, maintaining normal cholesterol levels and taking medications regularly is crucial. This can help reduce the risk of other diseases, such as heart disease or stroke.

When to see a doctor?

Xanthelasma usually does not require special treatment or removal. However, it is important to be aware of any diseases associated with high cholesterol levels. If you experience symptoms suggestive of xanthelasma, have your blood cholesterol levels checked by a doctor to determine if therapy is needed.

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