What are the other Names for this Condition? (Also known as/Synonyms)

• Xanthelasma
• XP (Xanthelasma Palpebrarum)

What is Xanthelasma Palpebrarum? (Definition/Background Information)

• Xanthelasma Palpebrarum (XP) is the formation of small yellow skin lesions, usually on the eyelids. It is described as a variant and the most common type of xanthoma
• The condition may be the result of abnormal cholesterol/lipid levels in blood. However, in nearly 50% of the cases, the cause of Xanthelasma Palpebrarum is not well-established
• Xanthelasma Palpebrarum is generally observed in adults. The lesions are usually benign, painless, and many in numbers. Since they usually involve the eyelids, the condition can give rise to cosmetic concerns
• The treatment of Xanthelasma Palpebrarum may involve the treatment of any underlying condition causing it, and the application of topical skin creams. If necessary, further procedures, such as cryotherapy, laser therapy, or surgical excision, may be considered
• The prognosis for Xanthelasma Palpebrarum is good with suitable treatment and recurrences are not normally reported

Who gets Xanthelasma Palpebrarum? (Age and Sex Distribution)

• Xanthelasma Palpebrarum is usually observed in middle-aged and older adults. A few cases have been occasionally reported in children and teenagers
• Both males and females may be affected; a female predominance is noted
• Individuals of all racial and ethnic background may be affected. Worldwide, no geographical localization has been reported

What are the Risk Factors for Xanthelasma Palpebrarum? (Predisposing Factors)

The risk factors for developing Xanthelasma Palpebrarum may include:

• Metabolic or genetic conditions causing elevated fat levels in blood (hyperlipidemia) or increased blood cholesterol levels (hypercholesterolemia): It is reported that about 50% of the individuals with Xanthelasma Palpebrarum have abnormal levels of fat/cholesterol in blood
• Use of certain medications
• Poorly-controlled diabetes
• Hypothyroidism or thyroid dysfunction
• High-fat diet and lack of physical activities/exercise
• High BMI levels: Obesity or overweight conditions
• Excess consumption of alcohol

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Xanthelasma Palpebrarum? (Etiology)

• The exact cause of development of Xanthelasma Palpebrarum is not well-established. In about half the cases, increased levels of lipid or LDL/VLDL cholesterol in blood are noted
• When the metabolism of fat/lipid is affected, lipids in blood combine with certain proteins to form water-insoluble lipoproteins, which accumulate beneath the skin to form xanthomas

What are the Signs and Symptoms of Xanthelasma Palpebrarum?

The signs and symptoms of Xanthelasma Palpebrarum may include:

• Presence of small, well-defined, flat skin lesions in the form of papules and plaques
• Several lesions may form around the eye, on the upper and lower eyelids; generally, the upper eyelids are affected
• The lesions may have yellowish discoloration
• They are usually painless; some are tender to touch
• When these increase in size, they are denoted as xanthomas. Some may grow large over many months, to form tumors
• In some individuals, the lesions are observed to form symmetrically around the eyes

Additional signs and symptoms of the underlying/associated condition (if any) may be noted.

How is Xanthelasma Palpebrarum Diagnosed?

A diagnosis of Xanthelasma Palpebrarum may involve the following:

• Complete physical examination and a thorough medical history evaluation
• Eye examination
• Test for blood cholesterol and lipid levels
• Dermoscopy: It is a diagnostic tool where a dermatologist examines the skin using a special magnified lens
• Wood’s lamp examination: In this procedure, the healthcare provider examines the skin using ultraviolet light. It is performed to examine the change in skin pigmentation
• Skin biopsy: A tissue biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis

Note: A biopsy may be performed to rule out other skin conditions with similar signs and symptoms.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Xanthelasma Palpebrarum?

The complications of Xanthelasma Palpebrarum may include:

• The presence of multiple lesions may result in cosmetic concerns (disfigurement) and emotional stress
• Scratching the lesions may lead to bleeding and ulceration, which may result in secondary infections. This may give rise to scar formation on healing
• Scarring may occur following the surgical removal of the lesions
• Complications that arise from the underlying genetic or metabolic disorder
• Some individuals with such metabolic disorders may have an increased risk for atherosclerosis

How is Xanthelasma Palpebrarum Treated?

The treatment of Xanthelasma Palpebrarum involves treating the skin condition, which may involve:

• Use of topical creams containing trichloroacetic acid (TCA)
• Laser therapy
• Cryosurgery or cryotherapy
• Curettage and electrodessication
• Surgical excision and removal of the xanthomas
• In some cases, removal of the lesions may not be necessary, unless they cause worrisome signs and symptoms such as cosmetic issues

Undertaking treatment of any associated metabolic condition to lower lipid/cholesterol levels in blood may be necessary.

How can Xanthelasma Palpebrarum be Prevented?

Currently, there are no known methods available to prevent the occurrence of Xanthelasma Palpebrarum.

What is the Prognosis of Xanthelasma Palpebrarum? (Outcomes/Resolutions)

• The prognosis of Xanthelasma Palpebrarum is good with appropriate treatment of the condition
• In some individuals, the surgical removal of the lesions may result in scarring

Additional and Relevant Useful Information for Xanthelasma Palpebrarum:

• Cleaning the skin too hard with strong chemicals or soaps may aggravate the skin condition. Care must be taken avoid strong soaps and chemicals that could potentially worsen the condition
• The presence of dirt on the body is not a causative factor for the condition. However, it helps to be clean and hygienic, which may help the condition from getting worse