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INTRODUCTION

Xanthelasmas, also referred to as xanthelasma palpebrarum, are plane xanthomas, occurring on the eyelids.

EPIDEMIOLOGY

Incidence: relatively common

Age: middle-aged adults

Precipitating factors: hyperlipidemia present in 50% of patients with xanthelasmas, family history of hyperlipedima, and xanthelsma. Younger adults who present with xanthelasma are more likely to have lipid abnormalities

PATHOGENESIS

Abnormalities of apolipoprotein E phenotypes or other lipoproteins.

PHYSICAL EXAMINATION

Xanthelasmas commonly present as multiple soft symmetrical oval yellowish papules and plaques on the eyelids.

DIFFERENTIAL DIAGNOSES

Syringomas, sebaceous neoplasms, milia, necrobiotic xanthogranuloma.

DERMATOPATHOLOGY

Collections of foam cells in the superficial dermis.

COURSE

They are generally permanent with tendency to increase in number and coalesce with time.

MANAGEMENT

Xanthelasmas often recur after treatment with any modality.

Surgical Excision

Surgical excision is the treatment of choice for xanthelasmas. The lesion is lifted and then excised using a blade or a Gradle scissor. The defect is either left to heal by second intention or sutured using silk or ethilon sutures (Fig. 50.1). This procedure usually results in a very cosmetically acceptable outcome.

Figure 50.1

Xanthelasma on the left upper medial eyelid in a middle-aged woman. (B) The resulting defect is sutured using ethilon sutures. This procedure produced a very good cosmetic result

Localized Tissue Destruction

CO2 or erbium laser vaporization, trichloroacetic acid, electrosurgery, or cryotherapy.

PITFALLS TO AVOID

  • Although 50% of patients with xanthelasmas are normolipemic, it is crucial to screen new patients with xanthelasmas for the presence of hyperlipidemia. This is particularly important in younger patients who present with xanthelasma since they are more likely to have associated lipid abnormalities.

  • Patients must be made aware that complete removal of the xanthelasmas does not prevent future development of new lesions.

  • Extreme caution should be exerted when operating on the eyelids in order to avoid eye injury.

BIBLIOGRAPHY

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Eedy  DJ. Treatment of xanthelasma by excision with secondary intention healing. Clin Exp Dermatol. 1996;21: 273–275.  [PubMed: 8959897]
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Ghosh  YK, Pradhan  E, Ahluwalia  HS. Excision of xanthelasmata—clamp, shave, and suture. Int J Dermatol. 2009;48(2):181–183.  [PubMed: 19200199]
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Hawk  JL. Cryotherapy may be effective for eyelid xanthelasma. Clin Exp Dermatol. 2000;25:351.  [PubMed: 10971501]
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Mannino  G, Papale  A, De Bella  F,  et al. Use of erbium:YAG laser in the treatment of palpebral xanthelasmas. Ophthalmic Surg Lasers. 2001;32:129–133.  [PubMed: 11300634]
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Nahas  TR, Marques  JC, ...

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