Definition Xanthelasmas
Xanthelasma is a yellowish plaque caused by lipid deposits (lipids are fats, especially cholesterol) in the upper and lower eyelid. They are harmless, in no case contagious and are not hereditary, although they can occur more frequently in families.
When do Xanthelasmas occur?
Xanthelasma can occur at any age, but is most common between the ages of 40 and 60. Women are affected more often than men, but also an unhealthy lifestyle, smoking, fatty food and overweight, as well as a predisposition to elevated cholesterol are risk factors for xanthelasma and subsequent stroke or heart attack.
Summary
In this clinical picture, lipids accumulate in the skin of the upper and/or lower eyelids. Lipids are fats. In older people this often happens without a cause, in younger people basic diseases must be excluded.
Xanthelasma can be recognized as yellowish pads. If desired, the affected skin areas can be cut out. Usually xanthelasma is located in the area of the inner corner of the eye.
The upper eyelid is affected more often than the lower eyelid. The xanthelasma is conspicuous by its raised surface and the yellow skin discoloration. Xanthelasma are soft and movable.
The course of the disease is very different: From long constant courses to the size and spread of increasing xanthelasma, everything was observed. Xanthelasma does not hurt and does not cause any other complaints, but is usually noticed by the affected persons or relatives as a cosmetic impairment. In rare cases, the function of the eyelids may be restricted, so that the eyelid hangs down more strongly on the affected side (ptosis).
If the underlying disease is present, symptoms may also occur, which are not caused by xanthelasma. Such fat deposits in cells also occur in other parts of the body, e.g. tendons. The diagnosis of xanthelasma is a visual diagnosis, because xanthelasma is visible to the naked eye.
Younger people should undergo further diagnostics, such as taking blood samples to determine blood values, in order to rule out an underlying disease (hyperlipidemia). Conservative: If there is a disturbance in the lipid metabolism, a therapy of the underlying disease with lipid-lowering drugs and diet is indicated in order to prevent the progression of the metabolic disorder and its numerous consequences. However, diet and lipid reducers usually have little effect on xanthelasma.
Surgical: To remove xanthelasma, it is removed surgically. There are various methods: excision, cauterization with HF devices or chloroacetic acid. Today, the procedure is mainly performed using laser ablation and CO2 laser.
Since the reason for the removal is usually exclusively cosmetic impairment, the statutory health insurance does not pay for the procedure. Regardless of which surgical method is chosen, care must be taken because the eyelid has a very special anatomy. If too much tissue is removed, the subsequent shrinkage of the scars can lead to an eyelid closure disorder (ectropion), so that drying of the eye surface (cornea) can follow.
Pigment disorders are also a complication risk, which would result in an aesthetically unsatisfactory surgical result. The surgical removal of xanthelasma becomes necessary if the patient suffers too much from the cosmetic impairment caused by xanthelasma or if the xanthelasma obstructs the closure of the eyelid due to its location and size. The xanthelasma itself is benign and therefore not necessarily removable.
The procedure is a quick routine matter and can be performed on an outpatient basis and under local anesthesia. The physician chooses either the traditional scalpel or a laser, which makes the treatment more expensive and complex without offering any cosmetic advantage. The affected skin area is cut out with the scalpel and the eyelid is then tightened.
Therefore, the operation is not always possible, as sufficient skin must be available to close the wound. The skin of the eyelids also tends to form recurrences. In 40% of the cases, new xanthelasma reappears in the same places after the removal, after the second operation it is already 60%.
Whatever type of surgical removal is chosen, the costs are always borne by the patient, as the procedure is covered by cosmetic treatments. One has to calculate about 250€, depending on the size and number of xanthelasma and the form of the therapy.In older people, xanthelasma often occurs without any apparent cause. However, if such lipids are found in the eyelid membranes of younger people, further clarification should be performed.
The reason is probably hyperlipidemia (hyper = (too) much; lipids = fats). The affected patients have thus dissolved too many fats in the blood. Normally, fats in the blood are absorbed by the responsible cells and transported to the liver to be metabolized.
Xanthelasma is therefore a disorder in fat metabolism, as a result of which the body stores the excess fat in the area around the eyes. The body has excess fat either because it absorbs too much fat when digesting food or because it does not process the fat properly. Approximately 50% of those affected can be diagnosed with such lipid metabolism disorders, such as Type II or Type IV hyperlipidemia.
This lipid metabolism disorder is often associated with diabetes mellitus. Xanthelasma can also occur in people with normal total cholesterol levels, but lowered HDL levels. It is important for affected persons to have an extended preventive examination by their family doctor, who can clarify an increased risk of cardiovascular diseases.
During the examination, blood pressure should be measured, weight and abdominal girth should be determined and a blood test for cholesterol and triglyceride values should be carried out. Furthermore, advanced technical procedures (e.g. ultrasound) can be used to examine the blood vessels for an existing disease. Thus a possibly existing arteriosclerosis (narrowing of the blood vessels due to deposits) can be diagnosed.
This arteriosclerosis can lead to strokes and heart attacks and should be checked regularly and supported by medication. If the xanthelasma is not completely removed, it can recur. Otherwise, there is no danger from the lipiein deposits.
If the xanthelasmas are so-called hard xanthelasmas, it is sometimes possible to scratch them in the course of a minor surgical procedure and to express them, so to speak. However, it is not possible to express the xanthelasma itself as one would do with conventional pimples. This is because, unlike pimples, xanthelasma is a chronic fatty deposit and not an acute inflammatory event with pus formation.
Therefore, affected persons should keep their hands off the xanthelasma and refrain from manipulating them, but rather consult a specialist for skin diseases. This doctor can offer professional help. Xanthelasma is caused by an oversupply of blood lipids in the body.
The body cannot deposit these in any other way and forms small pads on the eyelids. A pregnancy, which in hormonal terms means an enormous change for the mother-to-be, can lead to fluctuations and malfunctions in the metabolism, which also affects the formation of cholesterol. If new xanthelasma occurs during pregnancy or afterwards, the affected woman should consult a family doctor and have him/her search for possible causes.
It could be, for example, that (pregnancy) diabetes has developed or that an underactive thyroid has developed. Both could result in xanthelasma. However, since these are benign in nature and primarily disturbing from a cosmetic point of view, the patient does not have to worry about consequences for her or her child.
Xanthelasma is composed of so-called xanthoma or foam cells. These are histiocytes (macrophages, scavenger cells), which have a “foamy” cytoplasm due to the intracellular storage of fats (lipids). The composition of these lipids has a very high cholesterol content.
