Xantelasma
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- Localization. Eyes and appendages
- Erythematous lesion? Non-erythematous lesion
- Evolution time. Chronic: more than 2 weeks
- Skin lesion. Raised: papule, plaque or nodule
- Surface texture. Normal/smooth
- Edges Well defined and regular
- Color. Other colors: orange, yellow, gray
- Distribution of lesions. Discreet/isolated injury: 1 to 5 injuries
- Associated symptoms.
- Additional information.
Brief information
- Benign condition characterized by skin lesions (xanthomas) that occur on both eyelids (more common on the upper eyelids), usually symmetrical.
- More common in women, with a peak incidence between 30 and 50 years of age.
- They appear in the form of soft, semi-solid, yellow papules or plaques containing cholesterol.
- About half of patients with xanthelasma have associated lipid disorders that include type II hyperlipidemia, type IV hyperlipidemia, high total cholesterol, high triglycerides and low levels of high-density lipoprotein (HDL).
- However, around 25-70% of users with xanthelasma do not present changes in their lipid profile.
- Frequent association with: diabetes mellitus, hypothyroidism, cardiovascular disease, obesity, pancreatitis, hyperuricemia, smoking, chronic alcohol abuse.
- In children, the existence of hereditary dyslipidemia should be considered.
Differential diagnosis
- Necrobiotic xanthogranuloma
- Syringomas
- Erdheim-Chester disease
- Sebaceous hyperplasia
- Juvenile xanthogranuloma
- Nodular basal cell carcinoma
- Adult-onset asthma and periocular xanthogranuloma
- Eyelid sarcoidosis
- Lipoid proteinosis
Treatment
- Assessment of serum lipid and liver levels, glycemia and thyroid function.
- Reduction of lipid levels, although it may have a modest impact on existing xanthelasmas, through:
- Lifestyle modifications
- Lipid-lowering medications.
- Treatment is not medically necessary, but may be sought for cosmetic reasons. It is associated with high recurrence rates. Options include:
- Surgical excision
- laser therapy
- Cryotherapy
- Topical trichloroacetic acid.