Xanthelasma is a benign local fat accumulation in the skin, especially on or around the eyelids. The bulge is not painful and slowly grows larger. Sometimes, these fat humps are an expression of high cholesterol levels in the blood. The condition is often seen in the elderly or in middle-aged people.
Cause
Xanthelasma is caused by a disturbance in (local) fat metabolism. In some people, cholesterol content in the blood is too high, in others it is normal. There is evidence that patients with xanthelasma are more likely to have atherosclerosis. The condition can occur in the family. Xanthelasma is also considered as a form of skin aging.
Symptoms
Xanthelasmata are slightly raised spots, ranging in size from one millimeter to almost the entire eyelid. The spots look yellow and velvety, and they are often symmetrically spread over upper and lower eyelids. They occur in the eyelid skin, often at both eyelids. They are most common around the nasal corner of the eye and from there they extend to rest of the eyelid. They begin as small papules or nodules and over the months they develop into plaques. Sometimes, similar thickenings arise on elbow, knee or hand.
Although xanthelasma itself has few symptoms, the spots are well experienced as cosmetically disturbing.
Diagnosis
The diagnosis of xanthelasma is made on the clinical picture. In addition, blood is checked for elevated cholesterol and triglycerides (other fats) content.
Treatment
The spots can be surgically removed under local anesthesia and closed with stitches. This creates a small scar. If the spots are large, that’s not attractive. In case of recurrence, a second operation is more difficult.
Another possibility is to locally tap with trichloroacetic acid (TCA) solution. This highly etching liquid is applied to the spots, so that the fat is dissolved. The treated skin turns white. A scab is formed, that falls off after a few days. The spots are barely visible then. Sometimes, a second treatment is necessary. If the spots still come back after some time, they can easily be treated again.
The third option is CO2 laser treatment under local anesthesia. After treatment, there is a small superficial wound, that heals rapidly. This also provides very good cosmetic results and leaves no scar.
Prognosis
Xanthelasma will never disappear spontaneously, but will always remain benign. There has never emerged skin cancer from xanthelasma.
