Xanthelasma: Causes, Symptoms & Treatment

Xanthelasma, although harmless, can still cause severe discomfort to those affected. The deposits under the skin are usually located in highly visible areas and are therefore an aesthetic problem. People who notice xanthelasma on their skin should definitely see their doctor immediately.

What is a xanthelasma?

Xanthelasma are yellowish, sometimes reddish, fatty nodules in the skin of the eyelids. They appear symmetrically at the inner corner of the upper and lower eyelids. In most cases, the upper eyelids are affected. The sharply outlined fat deposits are usually soft (foam cells), consist mostly of cholesterol and can be moved with a little pressure. The overlying skin allows the lipid deposits to show through. Although they are not contagious and do not cause any other problems to their carrier, most people have them surgically removed. The unsightly fat nodules are caused by a disorder of lipid metabolism, which can be congenital or acquired. It usually appears after the age of 40. Women are affected more often than men.

Causes

When xanthelasma develops, the excess fat (mostly cholesterol), is stored in the form of foam cells under the skin surface. The cells are actually macrophages (scavenger cells) of the immune system. In patients with xanthelasma, the treating physician usually finds additionally elevated cholesterol levels, diabetes mellitus, alcohol-related cirrhosis of the liver or pancreatic inflammation (hyperlipidemic xanthelasma). However, people without pathologically elevated blood lipid levels can also suffer from xanthelasmas (normolipidemic xanthelasmas). Whether the tendency to xanthelasma can be inherited has not yet been conclusively clarified. Patients with xanthelasma who do not have high cholesterol levels are nevertheless considered a risk group by medical researchers:

They are more at risk of developing cardiovascular disease than people without the unsightly subcutaneous fat nodules. They suffer 50 percent more heart attacks than other people. Research also suggests that they have an increased tendency to deposit cholesterol into the walls of blood vessels (atherosclerosis). In addition, they may have primary biliary cirrhosis.

Symptoms, complaints, and signs

Xanthelasma are painless and not associated with any other symptoms of disease. Therefore, they are also considered a purely cosmetic problem: The cost of their removal is covered only by private health insurance companies. The fat deposits, which are perceived as emotionally distressing by those affected, sometimes even appear within a short period of time (eruptive xanthelasma). Sometimes the affected person also finds them in other parts of his body (tendon sheaths and extensor sides of elbows, knee joints, buttocks). There they are called xanthomas.

Diagnosis and course of the disease

Patients with xanthelasmata should first have their blood work checked to find out if their fatty deposits are due to a lipid metabolism disorder. The physician will determine cholesterol levels, blood glucose, thyroid levels, and uric acid levels. If the findings are positive, the underlying disease is treated. Despite therapy, the unsightly fat bubbles usually do not disappear on their own. In fact, over time, more and more xanthelasma may form on the eyelids. In addition, already existing ones can become even higher and wider. In rare cases, they can cause permanent drooping of the eyelid (ptosis).

Complications

Xanthelasma are not usually associated with complications. However, for many affected individuals, they represent a cosmetic problem that must be treated. If no treatment is given, for example because the health insurance company does not cover the costs, this often results in mental discomfort for the affected person. Social anxiety and depression can develop – problems that permanently limit well-being and quality of life. Serious psychological complaints are possible, especially in the case of spontaneous formation or spread of the fat deposits to other parts of the body. Physical complaints can occur if the affected person scratches the xanthelasma open or treats it improperly. Certain cosmetics can cause skin irritation and may also have an effect on the fat deposits. With surgical treatment, there is always a risk of scarring and adhesions.In addition, bleeding and wound healing disorders may occur. Scars may also remain after the application of trichloroacetic acid. If the xanthelasma is located in the area of the eyes, an ectropion may occur. Laser treatment may leave scars and cause burns. In addition, sensory disturbances may occur in the affected area. Allergic reactions are also possible, depending on the type of treatment.

When should you see a doctor?

In case of changes in skin appearance, a doctor should check the visual irregularities. If they occur suddenly and abruptly, they are often an indication of a health condition. Since there are risks of complications, a doctor should be consulted if the symptoms increase or if the inconsistencies persist. Although the xanthelasma do not show any disease value from a medical point of view, other skin diseases should be excluded. This is only possible if the affected person seeks the cooperation of a physician to clarify the cause. If nodules form or discolorations of the skin appear, this is in many cases to be understood as a warning signal of the organism. Often there are changes in the area of the eyelids. This can be unpleasant and lead to an optical blemish. Consultation with a doctor is advisable if states of mental or emotional stress arise due to the changes in the appearance of the skin. If there are strong feelings of shame or a withdrawal from social life, a visit to the doctor is necessary. In case of anxiety, decrease of cognitive performance or depressed mood, the affected person needs help. If vegetative disturbances, inner restlessness or never-ending brooding appear, a visit to the doctor is recommended.

Treatment and therapy

Since xanthelasma usually do not disappear even after treatment of the underlying disease, their surgical removal is recommended. Depending on the location and size of the nodules, they are removed with the help of electrocautery, cryosurgery, laser technology, surgical excision, and the application of trichloroacetic acid. The disadvantage of excision is that it usually leaves scars and the surgical site is very red for a long time. Since the annoying fat nodules usually reappear later in the same place, the surgical procedure is usually only useful if the patient also has an upper eyelid lift performed at the same time. The most frequently used and most successful method is laser treatment of xanthelasma. Erbium lasers, CO2, dye and argon lasers are used. They do not leave any visible scars. The lasered skin area is usually healed after a few days. After the second treatment at the latest, the xanthelasma has disappeared for good and will not reappear. The only disadvantage of laser treatment is that hypo- and hyper-pigmentation may appear later on the treated area in some patients. The application of 50 percent trichloroacetic acid has the disadvantage that it also leaves scars. In rare cases, it can even cause an ectropion (eyelid margin bent outward). Normal surgery – if there is too little skin at the xanthelasma site – can result in the eyelid not being able to close. In addition, (visible) scar shrinkage may occur.

Prevention

The patient cannot prevent the appearance of xanthelasma, because the exact factors that lead to it have not yet been one hundred percent clarified by medical research. However, regular monitoring of blood values can provide an initial indication of any blood lipid disorder that may be present. If the results are positive, a change in diet to a low-fat diet with a high content of omega-3 fatty acids and omega-6 fatty acids is recommended. Lipid-lowering agents additionally ensure normal blood lipid levels. A reduction diet can also help to better regulate lipid balance. With a healthier lifestyle, the patient can at least somewhat reduce the risk of xanthelasma occurrence. Instead of lipid-lowering drugs, he can also take Allium sativum in the potencies D2 to D6 (of the D6 drops 2 times a day 10). Artichoke extract and artichoke pressed juice also help lower cholesterol.

Aftercare

Skin abnormalities such as xanthelasma can be easily removed surgically. A local anesthetic ensures that patients enjoy a largely painless treatment. The procedure takes about 15 to 20 minutes.Afterwards, those affected can immediately go about their usual activities. However, care should be taken to avoid prolonged exposure to heat such as saunas or solariums for at least six weeks after treatment. Long and prolonged exposure to the sun should also be avoided. For the aftercare of xanthelasma, the physician prescribes an antibiotic ointment. Wound healing is possible without stitches. Accordingly, an appointment to remove stitches is not necessary. Patients are able to return to work and social activities within one to two days after treatment. Since the risk of recurrence is extremely high, a healthy diet is part of the aftercare. It is recommended to change to a diet rich in vegetables, fruits and fiber. In addition, it is advisable to stop smoking. Nicotine increases the risk of suffering from xanthelasma again. As a rule, the treating physicians advise in advance what should be considered in the aftercare and what it looks like. Since there are different ways to remove a xanthelasma, the type of aftercare also changes accordingly.

What you can do yourself

Xanthelasma lead to aesthetic irregularities and thus to an emotional challenge for those affected. Helpful in everyday life is a stable and healthy self-confidence. This protects against phases of severe sensitivities and can be an important pillar of support in coping with the disease. The symptoms improve when the body’s own weight is within the normal range of the BMI. Therefore, overweight and a fatty or excessively sweet diet should be avoided. At the same time, sufficient exercise should take place, as this stimulates the metabolism and helps to reduce existing excess weight. Emotional as well as physical stressors lead to a worsening of the overall situation, as they represent an additional burden for the entire organism. Therefore, everyday life should be checked for existing stress triggers and, if possible, persistent as well as negatively perceived stress in particular should be reduced. Cognitive training often helps to better handle everyday challenges. The overall strain on the heart should be reduced. Attractive leisure activities and a focus on activities that contribute to an improvement in well-being are therefore advisable. For many sufferers, a change in clothing style helps to significantly improve the quality of life by wearing loose and loose-fitting clothing. This can conceal self-perceived problem areas.