Xanthelasma (flat xanthoma of the eyelids) is a flat benign formation of yellowish color in the form of a slightly towering plaque. It is located more often on the upper eyelid at the inner corner of the eye. Xanthelasma can be single, multiple, or be one of the manifestations of xanthomatosis of the skin, in which plaques similar to xanthelasma are located on other parts of the body. The diagnosis is based on the appearance of the formation. When xanthelasma is detected, the blood lipid spectrum is examined. If its disorders are detected, therapy is aimed at correcting the content of lipids and cholesterol in the blood. To eliminate the cosmetic defect, xanthelasma is removed.
Xanthelasm got its name from the Greek words “xanthos” — golden yellow and “elasma” – plate. It affects mainly elderly people and most often women. A number of authors believe that xanthelasma can be considered as a marker of severe atherosclerosis and an increased risk of myocardial infarction.
The exact causes of xanthelasma are not known. Xanthomatosis of the skin develops against the background of impaired fat metabolism in the body and represents local deposits of fat in the papillary layer of the dermis. Although xanthelasmas in their structure practically do not differ from xanthomas, with their isolated appearance, according to analysis data, it is often not possible to detect significant violations of fat metabolism. Xanthelasmas and xanthomas are often observed in patients with obesity, diabetes mellitus, myxedema, lipoid nephrosis, pancreatitis, cirrhosis of the liver, high cholesterol in the blood.
Xanthomatosis may be hereditary in nature. In such cases, a genetically determined violation of fat metabolism develops. The disease manifests itself during the first year of life.
Xanthelasma is a slightly protruding yellow plaque located on the upper eyelid. It is painless when touched and has a soft consistency. As a rule, xanthelasmas appear on both eyelids. They can be singular and plural. In the latter case, xanthelasmas can merge, forming lumpy elements. Sometimes xanthelasmas merge into a solid yellow stripe with an uneven contour passing through the entire upper eyelid.
Xanthelasma is characterized by a sudden appearance, without previous changes in the skin of the eyelid. Its development occurs gradually and rather slowly, without delivering any subjective sensations to the patient. Xanthelasma can reach sizes from a small pea to a large bean. It never undergoes transformation into a malignant neoplasm and does not pose a threat to the human body. However, large and multiple xanthelasmas, despite their harmlessness from a medical point of view, represent a noticeable cosmetic problem.
If xanthelasmas are a manifestation of xanthomatosis, then they are often accompanied by a lesion of the lower eyelid, on which xanthomas are formed. At the same time, xanthomas are localized on other parts of the skin: the face, neck, knee and elbow joints, extensor surface of the limbs, buttocks, etc. They may appear on the mucous membrane of the soft and hard palate, lips. Xanthomas can be small-nodular (eruptive), flat in the form of plaques or lumpy in the form of large nodes with an uneven surface. The diameter of these formations varies from 2 mm to 5 cm. In some cases, xanthomas merge with each other and a large plaque with a lobular structure is formed.
The resulting xanthomas and xanthelasmas persist throughout life. Gradually they grow in size, their number increases. The appearance of xanthelasm and xanthomas in young children may be a sign of hereditary hypercholesterolemic xanthomatosis, which then manifests itself with disorders of the cardiovascular system and liver, may be accompanied by the formation of bone cysts.
Patients with xanthelasma are recommended to consult a dermatologist and an endocrinologist. The characteristic appearance and localization of xanthelasma make it possible to make a diagnosis immediately after examining the patient. When examining xanthelasma or xanthoma, pressing with a slide (diascopy) is used. In this way, they achieve the exsanguination of formations, which allows them to clearly see their yellow color.
Be sure to conduct a study of lipid metabolism. To do this, the determination of serum cholesterol and lipoproteins is prescribed. In some cases, a differential diagnosis with syringoma, elastic pseudoxanthoma and skin tumor diseases is necessary.
Xanthelasma has no specific treatment. If xanthelasm or xanthomatosis occurs against the background of a disease that may cause a violation of fat metabolism, treatment of this disease is necessary. According to the indications, insulin, thyroidin can be prescribed.
Patients with a detected violation of the lipid composition of the blood or an increase in cholesterol should adhere to a diet with a reduced content of animal fats. To do this, animal fats are replaced with vegetable fats, for example, sunflower and olive oil. Such patients with xanthelasma are prescribed lipotropic drugs and drugs that reduce cholesterol in the blood. These include: cetamiphene, pyricarbate, esters of unsaturated fatty acids, lipoic acid, thioctic acid, diosponine, clofibrate.
Of the preparations of plant origin, the following have a lipotropic effect: birch buds, dandelion root, rosehip fruits, corn stigmas, plantain juice, immortelle flowers. It should be remembered that these drugs have a choleretic effect and their use is contraindicated in cases of violations of the removal of bile through the biliary tract. In the treatment of xanthelasma, nicotinic and ascorbic acids, cyanocobalamin, pyridoxine, calcium pangamate, choline chloride are used.
Surgical treatment of xanthelasm is indicated for cosmetic reasons. It is carried out by excision of xanthelasm, its removal by laser, electrocoagulation, cryotherapy or destruction by radio wave method. Removal in most cases is performed under local anesthesia on an outpatient basis.
Small xanthelasmas are usually removed by diathermocoagulation. Larger plaques are separated with scissors and tweezers. The edges of the wound are reduced and lubricated with ferric chloride, which forms a strong scab and allows the wound to heal by primary tension for 1-1.5 weeks. After separation, xanthelasm with a wide base of the wound edge is cauterized by diothermocoagulation. When xanthelasm is combined with overhanging of the skin fold on the eyelid, their surgical excision is performed together with an excess of the skin of the upper eyelid.
To prevent the redidivation of xanthelasma after surgery, the patient is recommended a dairy-vegetable diet with the exception of animal fats and restriction of carbohydrates. The daily norm of butter should not exceed 25g, sunflower — 75g.