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Xanthelasma: Causes and Treatment for Yellowish Spots Around the Eyes

Xanthelasma is a condition that causes people to develop flat, yellowish spots or plaques around their eyes. These spots can indicate elevated cholesterol, which is why it’s important to diagnose them. 

Read on to learn more about xanthelasma, what causes it, and how it can be treated.

Xanthelasma palpebrarum (XP) causes yellowish papules, spots, and plaques that result from localized deposits of lipids, such as cholesterol. 

Xanthelasma usually affects eyelids, especially the upper eyelid. Xanthelasma palpebrarum is the most common form of cutaneous xanthomas.

These skin lesions develop when macrophages (a type of cell that eats other substances) accumulate fat in the skin, eventually forming what are called xanthomas. They can develop in people of nearly any age, from 15 to 73 years old, but they’re more common between the ages of 40 and 50. When someone develops xanthelasma before they’re 30, they should be tested for alterations in their lipid metabolism.

Xanthelasma isn’t painful and doesn’t lead to health complications; however, the spots can affect people’s self-image and disfigure their eyelids.

Xanthelasma is characterized by the formation of flat, yellowish plaques that commonly affect the inner portion of the upper eyelid. It’s important to seek medical assistance so that your health care provider is able to determine the cause of the lesions since other conditions can cause similar symptoms.

Xanthelasma can be confused with milia or milium cysts, which are small white bumps that appear on the skin. Milia are small cysts that contain keratin. They commonly appear under the eyes, but they can also affect your nose, cheeks, or other parts of your body.

Milia develop just below the epidermis or outermost layer of your skin, and they’re usually 1 to 2 millimeters in size. These lesions are often confused with whiteheads, but they don’t contain pus and shouldn’t be scratched or squeezed.

These white spots occur when dead skin cells or keratin build up under your skin, forming raised bumps. Milia aren’t related to clogged pores or lifestyle or diet habits.

Most cases of milia don’t require medical treatment and usually clear up on their own after a few months. Different techniques can remove milia when necessary. If you have milia, your dermatologist will be able to evaluate your case and recommend the most effective treatment for you.

Your health care provider should be able to diagnose xanthelasma after closely examining the skin around your eyes. Unlike milia, xanthelasma lesions are usually on the inner half of the upper eyelids, and they tend to be yellowish in color. These lesions are soft and start small, but they can grow and form yellowish plaques on your eyelids over time — usually several months. This can give the appearance of discoloration on your eyelids.

Xanthelasma lesions are usually symmetrical across both eyes. They can feel semisolid or hard to the touch.

In most cases, xanthoma palpebrarum won’t affect the function of your eyelids. But in some cases, this condition can cause ptosis, which is a drooping of the upper eyelid. Serious cases of ptosis may lead to difficulties keeping the affected eye open.

Xanthomas are cholesterol deposits that can affect any part of your body. Xanthoma palpebrarum may or may not be related to alterations in your lipid metabolism. In some cases, XP on your eyes can be a symptom of high cholesterol.

Lipids bind to proteins inside our bodies to form compounds called lipoproteins. There are several types of lipoproteins in our blood, including chylomicrons, very-low-density lipoproteins, low-density lipoproteins (LDL), and high-density lipoproteins (HDL). When the levels of one or more of these lipoproteins become altered, dyslipidemia can result.

Xanthomas can be a manifestation of primary hyperlipidemia, which is usually linked to your genes. People with primary hyperlipidemia may have low levels of “good” cholesterol (HDL) and elevated levels of “bad” cholesterol (LDL). The elevation of lipoproteins caused by this condition can lead to cutaneous xanthomas.

Secondary hyperlipidemia, in which the lipid alteration is caused by an underlying condition, can also result in xanthomas. Conditions that can result in secondary hyperlipidemia include:

  • Hypothyroidism
  • Diabetes mellitus
  • Obesity
  • Nephrotic syndrome, a type of kidney disease
  • Certain types of liver disease
  • Systemic lupus erythematosus
  • A diet rich in cholesterol, saturated fats, or alcohol
  • Certain drugs such as steroids, estrogens, retinoids, and certain antihypertensive drugs

Xanthelasma has also been linked to other medical conditions in patients with a normal lipid profile. Other causes of XP include erythroderma, inflammatory skin disorders, and allergic contact dermatitis.

Since xanthelasma is often linked to lipid disorders, it’s important for people experiencing it to have their lipid levels tested. These tests may include:

  • Triglycerides
  • Total cholesterol
  • HDL
  • LDL
  • Apolipoprotein B100

Lifestyle modifications can be very useful in the management of XP. These modifications include regular exercise, following a low-fat diet, avoiding unhealthy fast food and added sugars, and in some cases, taking lipid-lowering drugs.

Surgical procedures can remove xanthomas that don’t resolve after the underlying cause has been treated. These treatments include the following:

  • Full-thickness skin excision involves removing the lesion down to the fatty subcutaneous tissue. Significant scarring is more likely to result when this procedure is used on the lower lid since it’s usually thicker than the upper eyelid. The excision of larger lesions may result in eyelid retraction, ectropion, or damage that requires further reconstructive surgery.
  • Laser therapy uses energy to destroy foam cells, which are filled with fat, in the skin. The laser coagulates the wound immediately, preventing bleeding, scarring, inflammation, and rates of recurrence.
  • Radiofrequency is an easy, safe, and inexpensive treatment for xanthelasma. A radiofrequency current is used to reduce the volume of the affected tissue in a controlled manner, which continues during the healing period. The necrotic tissue that results from this procedure is then reabsorbed naturally by the body, with minimal impact on healthy, surrounding tissues.
  • Trichloroacetic acid (TCA) is applied on the lesion to destroy the fatty cells. You may require several applications of this treatment before experiencing optimal results. The most common side effect of the TCA application is hypopigmentation.
  • Cryosurgery is a relatively painless, safe, and effective outpatient procedure, but it requires multiple sessions. This technique uses liquid nitrogen to freeze and destroy the xanthelasma plaques.

Xanthelasma palpebrarum causes small, yellowish plaques to form over the eyelids, and they’re the most common type of cutaneous xanthoma. These lesions can be a manifestation of elevated cholesterol levels, but they have also been linked to other disorders.

Although these lesions are benign, they can signal underlying conditions that require medical treatment. Seek medical assistance if you notice white or yellow spots around your eyes. Your health care provider will be able to provide an accurate diagnosis and determine the best course of treatment for your case.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5921443/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5739544/

https://www.sciencedirect.com/topics/medicine-and-dentistry/xanthelasma

https://dermnetnz.org/topics/milium/

https://dermnetnz.org/topics/xanthoma/