Xanthelasma

What is Xanthelasma?

Xanthelasma palpebrarum is a disease characterized by irregular yellow patches or plaque around the eyes or inside the corners of eyelids. It is not a fatal disease and just a deposit of rich fat and lipid which affects the physical look of a person.

How common is Xanthelasma?

More common in women than in men, in western countries, 32% of the reported cases are related to women while 17.4% cases to men. Xanthelasma is a type of Xanthoma (rich cholesterol deposition in the form of cutaneous nodules) that is not painful. However, it can be an indication of cardiovascular diseases in an individual. The age groups of 30-50 years have more chances to suffer from this disorder.

Another type of Xanthoma is ‘Palmer’ that is quite close to Xanthelasma concerning features. The only difference is the ‘site,’ as the Palmer happens near the palm and finger area while Xanthelasma around the eyelids.

Causes

The irregular metabolism and an increase in cholesterol level give rise to this disorder. The excessive presence of lipids, cholesterol and other fatty components in the bloodstream is the primary cause. Xanthelasma characterizes the unusual lesions around the eyes caused due to the accumulation of fatty materials in cells under the skin. Some causing factors of Xanthelasma are:

Familial Mixed Hyperlipidemia

It promotes the increment of the ‘triglyceride’ and ‘cholesterol’ levels in the bloodstream of a person. The other types of inherited Hyperlipidemia caused due to mutation is the pattern of lipoprotein Type II or Type IV. But this form is genetically different.

Low-Density Lipoprotein (LDL) Deficiency

The lack of LDL or ‘Bad cholesterol’ in the blood can cause many skin problems.

Cerebrotendinous Xanthomatosis (CTX)

It is a genetic disorder that affects the breakdown of cholesterol in the body. Hence, in the absence of proper break down of cholesterol in the body, it results in excessive accumulation of cholesterol. Xanthelasma is also an attribute of the genetic element that is more common in the people of Asian and Mediterranean origin.

Other Causes

  • Increased level of fat in the blood
  • Metabolic disorders like diabetes
  • High level of cholesterol and triglyceride in body
  • High-Density Lipoprotein (HDL)
  • High blood pressure
  • Obesity
  • Biliary cirrhosis (a liver disease)
  • Smoking
  • Unusual weight gain

Diagnosis

Lipid profile tests diagnose xanthelasma and doctors mostly examine this disease visually due to its appearance. This condition perfectly gets diagnosed by a dermatologist or specialist of skin disorders. Physical examination of the skin is the initial level of diagnosis. Doctors also perform blood lipid tests to assure the presence of a high level of lipids in the bloodstream.

‘Biopsy’ is the preferred technique in case of the suspected cancerous condition and benign nodule. Sometimes the patients go through blood tests to detect the changes in lipid levels or liver function. Blood tests also help in the diagnosis of diabetes in this case.

Differential Diagnosis

Some disorders are quite identical to Xanthelasma. Therefore at times, they are often misdiagnosed. Hence, the differential diagnosis include:

  • Epidermoid cysts: Unilateral and differ in color
  • Basal cell carcinoma: Red cluster type appearance on the skin with central umbilication
  • Milia: White and spherical cyst
  • Syrongamus: Skin colored minute papules on the lower
  • Sebaceous hyperplasia: Condition of the increased size of sebaceous glands on the face and forehead
  • Molluscum contagiosum: A skin infection caused due to DNA poxvirus that forms smooth papules with central umbilication on the skin
  • Amyloidosis: Formation of the mucosal lesion on the skin or within eyes
  • Lipoid proteinosis: Disorder that characterizes translucent (hyaline) material in the skin, mucosa or larynx.
  • Xanthoma disseminatum (Montgomery syndrome): Disease in children and adults where skin gets affected by brown and yellow lipid-content.

Treatment

Non-invasive treatment

Non-invasive treatment is a primary treatment suggested to the people with high cholesterol level. Few measures include:

  • Changes in dietary plans: Involves a reduction in the consumption of foods rich in fats, lipids, and cholesterol. Avoiding salts and spice is highly beneficial. Consuming more vegetables and fruits enhances the appearance of the skin.
  • Regular exercise: Also includes yoga, it helps the person to lose body weight by reducing the fat content. The workouts on a daily basis control the level of triglyceride and cholesterol in the body. A decrease in the fat deposition naturally will check the skin problems.
  • Medications: Sometimes, patients are recommended with medicines to lower the cholesterol. They are prescribed to reduce the number of nodule formation over the skin.

Invasive treatment

They are needed when non-invasive treatment fails. If one feels cosmetically unattractive, then removal of lesions are required. However, the removal of the lesion is not a matter of concern as it does not produce any uncomfortable symptoms. Chemocautery, Cryotherapy, and surgical excision are the methods for removing the nodules. These techniques sometimes cause scarring or skin’s color change in affected regions. The nodule growth can recur after the surgery.

 Xanthelasma removal

As discussed above, the lesions don’t need mandatory removal until and unless a patient wishes due to cosmetic factors. These nodules are harmless and asymptomatic, and their removal includes techniques like:

  • Cryotherapy: Follows the procedure of spraying liquid nitrogen over lesions that freezes them and results in shrunk plaques. Finally, it eradicates the tissues filled with fat and eventually the nodules. Cryocautery is another name for this therapy.
  • Chemotherapy: The use of effective chemical over plaques leads to the removal of nodules and rapidly controls the abnormal growth.
  • Surgical Excision: The technique involves shearing or shaving off the lesions with the help of sharp equipment. The bumps that will arise anyway over eyelid so normal surgery can remove it easily.
  • Other methods: They include Trichloracetic Acid Therapy (TCA), Argon laser treatment, skin grafting (In the case of large lesions) and chemical peels.

However, surgery does not ensure permanent removal of the plaques. These papules can reoccur to the patients even after removal.

Xanthelasma Home Remedies

These treatments also do not ensure the permanent cure, but they are effective. Although, there is no specific home remedy, to avoid the medical treatment the possible methods include:

Garlic Therapy

It suggests applying the garlic cloves on the affected region. By pressing the half cut garlic from the mid on lesions, one allows the garlic juice to spread over them. This mild burning sensation indicates the effectiveness of this therapy as the process makes nodules shrink. Garlic therapy needs repetition over four to five days for a positive outcome. This popular therapy works best with fresh and oily garlic.

Frequent Breaks

The frequent breaks and stretch while working in an office or watching TV can provide the person a needed exercise in a short period. Eventually, it will burn some amount of calories.

Exfoliation

People affected with Xanthelasma sometimes scrub the affected region or after surgery, the skin color gets changed. This requires exfoliation which is a condition of achieving the unblemished and clean appearance by using a deep cleanser or exfoliating scrub. It is the stage of removal of old skin.

Prevention

Reducing cholesterol from the body is the only way to prevent the occurrence of Xanthelasma. Some changes in diet chart and lifestyle can lead to lower the cholesterol and fat like:

  • Limiting smoking habits
  • Avoiding alcohol consumption
  • Avoid consuming saturated fat
  • Regular Exercise

Complications

If the nodules are left untreated, they don’t cause any complications. The main complications happen due to the negligence of high blood cholesterol often resulting in increased blood pressure. In many cases, deposition of cholesterol causes ‘Atherosclerosis’ that is a condition of hardened and contracted arteries. Consequently, Atherosclerosis may lead to other genuine problems such as Ischemic stroke, Myocardial infarction and sometimes even death.

The Xanthelasma lesions present around the eye region generally do not harm or obstruct the function of eye or eyelid. However, there is a minimal chance that it may cause the ‘ptosis’ which is a condition of drooping eyelids.  The nodules change the cosmetic figuring, i.e. physical appearance of an individual. The nodules also depict the upsurged lipid level in the bloodstream that eventually indicates the risk of heart ailments in patients.

Prognosis

Xanthelasma can recur even after proper treatment. The outcome depends upon the prevention and condition of cardiovascular risks. Proper management and treatment can provide a satisfactory prognosis. However, hyperlipidemia assessment is also one of the important factors to determine the positive prognosis.

When to refer a doctor?

Xanthelasma is a cosmetic disorder and a common form of xanthoma. When an individual sees the appearance of nodules or clusters of yellow-orange color around eyes, then he/she should consult the doctor.

References

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