Xanthelasma

The appearance is of yellow flat plaques over the upper or lower eyelids. In other areas of the body the individual lesion would be called a xanthoma.

Usually not a problem, since colour and site are characteristic. Sometimes syringomas and milia may be misdiagnosed as xanthelasma. Syringomas are small papules on lower eyelids and are skin coloured. Large milial cysts are white and spherical. Xanthomas in other areas may appear more orange-yellow.

Xanthelasma may be associated with familial hyperlipidaemia.¹ Patients with these lesions therefore frequently also have arcus senilis and xanthomas in other areas of the body. The presence of xanthelasma and corneal arcus indicates a higher risk of developing ischaemic heart disease, but not peripheral vascular disease.² Secondary hyperlipidaemia can also be an association, usually caused by underlying uncontrolled diabetes.³ Some patients exhibiting xanthelasma have normal lipid levels.

The lesions can be left alone unless the patient wishes them removed for cosmetic reasons. Various options are available including surgical excision, chemical treatment with trichloracetic acid, carbon dioxide and argon laser treatment, and cryocautery.³

Patients should have their fasting lipid levels checked, and those with hyperlipidaemia should have a formal cardiovascular risk assessment using appropriate charts. If the ten-year risk of cardiovascular disease is assessed at greater than 10%, lifestyle intervention should be considered as per primary prevention of cardiovascular risk protocols . If the risk is 20% or greater, intervention might include the use of aspirin and lipid lowering drugs.⁴

The condition itself if harmless. Up to 40% of lesions recur after treatment.³ Any associated comorbidity will of course affect prognosis.

Surgical excision and cryocautery may be available in primary care, but it is likely that the other treatment options will require secondary care referral.