Xanthelasmas are yellowish spots on the inner aspects of the upper and lower eyelid that are due to fat deposits in the skin.
Xanthelasma is more common in women. It can occur at any age, but most common in the 40s and 50s.
Although Xanthelasma is benign they are not considered dangerous in the medical sense and rarely cause functional problems. However due to its appearance, Xanthelasma causes significant psychological distress due to the cosmetic disfigurement.
There is no known cause, but it may indicate an underlying plasma lipid disorder in approximately 50% of patients caused by lipid, cholesterol, lipoprotein or apolipoprotein abnormality. Therefore, patients should be tested for underlying causes of hyperlipidaemia.
Presence of Xanthelasma appeared to be a predictor of risk for myocardial infarction, ischemic heart disease, severe atherosclerosis, and death in the general population. Christofferson M et al. BMJ. 2011; 343: d5497
Xanthelasma starts small and gradually grows. It is easier to treat small lesion as they are located in the inner part of the eyelid where there limited amount of excess skin. So, if you treat this early one can get a good cosmetic result without causing any secondary eyelid problems such tight scar that may result in difficulty closing the eye.
Since Xanthelasma is asymptomatic, it will not cause any functional problems. As it gradually grows bigger it will become more visible and harder to cover up with make-up. Since xanthelasma occurs on the inner aspect of the upper eyelids where there is less skin, surgical excision is easier when the xanthelasma spots are smaller.
The yellowish patches on the eyelid skin show numerous clusters of cholesterol laden histiocytes or foam cells involving the entire thickness of the dermis of the eyelid skin, hence excising the entire thickness of the skin is essential treatment
Surgery is the best form of treatment because it is easy to remove the full thickness of the skin and easy to close if the defect is small. The eyelid wound will heal in 2 weeks and the scar will be barely visible in 3- 4 months. A skilled Plastic Surgeon will be able to give you a good result with a combination of technical expertise and aesthetic finesse.
Systemic therapy using anti-cholesterol agents like Probucol and Alirocumab
Topical therapy such at TCA chemical peel, Liquid Nitrogen cryotherapy
Energy Based Devices like Radio Frequency ablation, laser ablation, CO2 laser, Erbium laser, Nd:YAG laser, Argon Laser, KTP laser
Unfortunately, recurrence is seen following treatment of Xanthelasma as the underlying cause remains elusive to diagnose and difficult to treat.
All surgery carries risk. A second opinion from an appropriately qualified health practitioner is recommended before proceeding