Xanthelasma (lid xanthelasma; lid xanthoma; plane xanthoma of the eyelids; xanthelasma palpebrarum; xanthelasma of the eyelids; ICD-10 H02.6) are yellowish, raised plates in the tissues of the upper and lower eyelids that contain cholesterol. They are classified as xanthomas of the skin. This skin change is benign (benign), but has a cosmetically disturbing effect. Women are affected more often than men:
Menopausal women are particularly frequently affected. Frequency peak: The peak of the disease is in the 4th and 5th decade of life.
Course and prognosis: There is no spontaneous regression. If dyslipidemia (lipid metabolism disorder) is the cause of xanthelasma, the development of atherosclerosis with its sequelae should be given special attention.
Note: A 33-year follow-up study of 12,745 individuals showed that xanthelasma is an important skin marker for atherosclerosis (arteriosclerosis, hardening of the arteries), independent of lipid levels. Individuals with this skin marker have an additional risk factor for myocardial infarction (heart attack) and ischemic heart disease (coronary artery disease, CAD; coronary artery disease).
Symptoms – Complaints
Xanthelasma are 0.1-2.0-cm, yellowish, raised strip-like patches, plaques (patchy or plate-like substance proliferation of the skin), or papules (nodule-like skin change) in the eyelid area that are smooth-surfaced and contain cholesterol. They are usually cushion-like soft and easily displaced and occur symmetrically on both eyes. They may be more than one centimeter in size.
Differential diagnoses
One must differentiate syringomas (malformation of sweat glands) and milia (grains of semolina) from xanthelasma.
Pathogenesis (disease development) – etiology (causes)
In most cases, xanthelasmas are idiopathic (“without known cause”).
Xanthomas may also be indicative of dyslipidemia (hyperlipoproteinemia; type II or type IV hyperlipidemia). Diabetes mellitus may also be a cause of fatty deposits. An association has also been noted with hypertension (high blood pressure). In older age, xanthelasma may also occur independently of disease (with normal total cholesterol).
Diagnostics
Xanthelasma are detected by visual diagnosis on the basis of the typical picture.
Therapy
- Screening for total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides; treatment of dyslipoproteinemia (lipid metabolism disorder), if present.
- Surgical removal (excision) has long been the first-line treatment; other procedures include:
- Electrocautery (surgical tissue destruction by application of electric current/electrocoagulation).
- Laser therapy: different lasers are available for this purpose, such as the CO2 laser, the erbium Yag laser or the dye laser.
- Cold therapy (cryotherapy) (frequent use).
