Xanthelasmas, also referred to as xanthelasma palpebrarum, are plane xanthomas, occurring on the eyelids.
Incidence: relatively common
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
Abnormalities of apolipoprotein E phenotypes or other lipoproteins.
Xanthelasmas commonly present as multiple soft symmetrical oval yellowish papules and plaques on the eyelids.
Syringomas, sebaceous neoplasms, milia, necrobiotic xanthogranuloma.
Collections of foam cells in the superficial dermis.
They are generally permanent with tendency to increase in number and coalesce with time.
Xanthelasmas often recur after treatment with any modality.
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.
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.
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.
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