Derm Dx: Asymptomatic Lesion Above the Left Eye

Xanthomas are benign lesions composed of cholesterol-rich depositions in the connective tissue of the skin, tendons, or fascia. Xanthelasma — or xanthelasma palpebrarum — is the most common cutaneous xanthoma and typically presents in the medial canthal area of the...

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Xanthomas are benign lesions composed of cholesterol-rich depositions in the connective tissue of the skin, tendons, or fascia. Xanthelasma — or xanthelasma palpebrarum — is the most common cutaneous xanthoma and typically presents in the medial canthal area of the eyelid.¹ “Xanthos” translates to “yellow” and “elasma” to “plate” in Greek; xanthelasma presents as a single or multiple symmetrical yellow, soft, slightly elevated lesions on the upper or lower eyelid region.¹ The lesions most commonly present in patients aged 40 to 50 years.¹ Xanthelasma formation in children and young adolescents is typically associated with inborn or acquired dyslipidemia disorders and can signify an increased risk for metabolic or cardiovascular diseases.²

Xanthelasma development occurs as a result of an excessive uptake of low-density lipoprotein particles through the vascular wall into the interstitial area of connective tissues surrounding the eye.² Diagnosis of xanthelasma is primarily guided by history and physical examination. Laboratory assessment may be indicated to rule out lipid abnormality and biopsy if atypical in appearance.  Xanthelasma formation has been associated with thyroid disorders, diabetes, inflammatory skin disorders, and medication use (eg, glucocorticoids, cyclosporine, cimetidine, and tamoxifen).³

As xanthelasma is benign and asymptomatic, treatment is typically sought for cosmetic reasons. Surgical removal is readily accomplished but may uncommonly result in scar formation.³ Other options for lesion removal include laser, cryosurgery, and trichloroacetic acid application.⁴ Treatment options should be individualized based on the size and location of the lesion, patient preference, and provider experience. If the patient has an underlying medical condition with an abnormal lipid profile, referral for medical treatment and lifestyle modifications are advised.

References

1. Roy FH, Fraunfelder FW, Fraunfelder FT. Roy and Fraunfelder’s Current Ocular Therapy. 6th ed. Philadelphia, PA: Saunders Elsevier; 2007:464.
2. Zak A, Zeman M, Slaby A, Vecka A. Xanthomas: clinical and pathophysiological relations. Biomed Pap Med Fac Univ Palacky Olomouc Czech Republic. 2014;158(2):181-188.
3. Nair PA, Singhal R. Xanthelasma palpebrarum – a brief review. Clin Cosmet Investig Dermatol. 2018;11:1-5.
4. Laftah Z, Al-Niami F. Xanthelasma: an update on treatment modalities. J Cutan Aesthet Surg. 2018;11(1):1-6.