What is the diagnosis and treatment for Xanthelasma (yellowish patches on the skin, also known as xanthelasma palpebrarum)?

From the Guidelines

Xanthelasma should be treated with cosmetic removal through surgical excision, laser therapy, chemical cauterization with trichloroacetic acid, or cryotherapy, and underlying lipid abnormalities should be addressed to reduce the risk of recurrence and associated cardiovascular risk. Xanthelasma are yellowish, slightly raised cholesterol deposits that appear on the skin around the eyes, most commonly on the inner corners of the eyelids. These benign lesions are often associated with elevated blood lipid levels, particularly LDL cholesterol, though they can occur in people with normal cholesterol levels as well 1.

Key Considerations

• If you have xanthelasma, it's essential to have your cholesterol levels checked, as they may indicate an underlying lipid disorder 1.
• Lifestyle modifications like a low-fat diet, regular exercise, and avoiding smoking can help manage both xanthelasma and associated cholesterol issues.
• Medications such as statins (like atorvastatin 10-80mg daily or rosuvastatin 5-40mg daily) may be prescribed if high cholesterol is present.
• The presence of xanthelasma, particularly in younger individuals without family history, warrants cardiovascular risk assessment as it may signal increased risk for heart disease.

Associated Conditions

• Xanthelasma can be associated with Erdheim-Chester disease (ECD), a rare histiocytic neoplasm that can involve multiple organ systems, including the skin, bones, and cardiovascular system 1.
• ECD can present with a range of symptoms, including xanthelasma, bone pain, and cardiovascular abnormalities, and requires a comprehensive evaluation and treatment approach 1.

From the Research

Definition and Association of Xanthelasma

• Xanthelasma palpebrarum is a common periorbital lesion that occurs in middle-aged women, characterized by the localized accumulation of lipid deposits on the eyelids 2, 3.
• It is often associated with dyslipidemia, with studies showing a higher incidence of dyslipidemia in patients with xanthelasma compared to the general population 2.

Treatment Modalities

• Various treatment methods are available for xanthelasma, including surgical excision, laser therapy, electrosurgical techniques, chemical peeling, cryotherapy, and intralesional injection 3, 4.
• Laser modalities, such as carbon dioxide, Er:YAG, and pulsed dye lasers, have shown moderate to excellent clearance rates with minimal side effects 5, 6.
• Surgical excision is often used for larger and deeper lesions, while laser and electrosurgical techniques are more suitable for smaller and superficial lesions 4.

Efficacy and Safety of Treatment Modalities

• Er:YAG laser therapy has been shown to be an effective and safe treatment modality for xanthelasma, with complete removal of lesions and minimal recurrence rates 5.
• A systematic review of laser therapy in xanthelasma palpebrarum found that all laser modalities offered moderate to excellent clearance rates with minimal side effects 6.
• Comparative studies have reported better efficacy for CO2 laser than Er:YAG laser and trichloroacetic acid, but further large-scale studies are needed to determine the best treatment modality 4.

Recurrence and Complications

• The recurrence rate of xanthelasma after treatment varies, with a reported rate of 17.5% after surgical excision and 10.5% after Er:YAG laser therapy 2, 5.
• Complications of treatment, such as dyspigmentation and hypertrophic scarring, are minimal but can occur, especially with certain laser modalities 4, 5.