Xanthelasma Palpebrarum

What Is Xanthelasma Palpebrarum ?

Also known as xanthelasma palpebrum, these planar, yellow-to-gray plaques can be found on the eyelids and periorbital skin area. They are the most frequent and least specific of most xanthomas.

They will not normally cause pain to the sufferer, but they can be cosmetically disfiguring and thus cause embarrassment and depression, due to their visual nature.

External Xanthomas and especially Xanthelasma, can take many forms, and they may be soft, semisolid, or calcareous. They often form in symmetrical patches, and the upper eyelids are more frequently affected than the lower lids. In many cases, all 4 lids are involved.

They often range in size from 2 – 30mm and are flat surfaced and have distinct borders, and they will often grow in size and in number over time. They are ‘foamy’ in nature and classed as a cutaneous necro-biotic disorder. 

When observed in isolation, xanthelasma can present a diagnostic problem because one-half of patients with it have normal lipid levels.

However, their existence, especially in a young patient, justifies an extensive history, physical examination, and investigation of your fasting plasma lipid levels.

So, What Is The Xanthelasma Definition? 

Xanthelasma are the cutaneous manifestations of lipidosis, a condition in which lipids (molecules that naturally occur in the body, lipids include sterols fat-soluble vitamins A, D, E, and K, fats, waxes, monoglycerides, diglycerides, triglycerides and phospholipids) cluster in skin cells and become visible on the surface. 

Basically, xanthelasma is the deposit of cholesterol in the white blood cells of the skin, resulting in the formation of yellow plaques on the surface.

There are a number of types of xanthelasma based on different pathologies. However, the original xanthelasma definition stays the same. Here we describe the many types as well as the clinical presentation of this disease. 

Tests for Xanthelasma

Characteristic appearance on physical examination

As the Xanthelasma definition states, these lesions appear as planar, yellow-to-gray plaques present on the eyelids and the periorbital epidermis

Serologic tests.

Carrying out a fasting lipid level test can readily determine whether a patient’s xanthelasma was a consequence of hyperlipidemia in the first place. Clinicians should test patients with xanthelasma, particularly if they are young or have multiple family histories with early on atherosclerotic disease. 

Diagnosis confirmation.

The positioning of xanthelasma creates a confusion. One significant differential diagnosis is an appendageal tumor. It is important to rule out any malignancy and this is best done by examining the tissue under a microscope. 

Who Is Vulnerable To This Skin Condition ?.

As the Xanthelasma definition implies, it can happen in a number of hereditary disorders of lipoprotein metabolism including homozygous and heterozygous familial hypercholesterolemia, familial dysbetalipoproteinemia (type III), and in systemic disease.

What Is The Reason For The Skin Condition?

Many times it is the lipid that is at the root of this disorder, as is evident by the xanthelasma definition. There may be good proof that the lipid found within xanthomas is the same lipid circulating in high concentrations in the plasma of patients.

However, the precise mechanisms that result in xanthoma development are less clear. It’s been proven that scavenger receptors for low-density lipoprotein (LDL), present on macrophages can take-up lipid. This converts them into foam skin cells.

It has additionally been proven that extravasated lipid can produce foam skin cells by inducing vascular endothelial receptors.

Furthermore, oxidized low-density lipoprotein has been proven to be involved in the creation and infiltration of foam skin cells within the dermis. Local factors like temperature, activity, and friction may increase LDL leakage from capillaries. This further aggravates the condition.

Systemic Implications and Complications

The basic xanthelasma definition should allow the clinician to check for complications of hyperlipidemia. These patients should be screened for lipid abnormalities and also have vigilant treatment of their lipid derangement to decrease the development of atherosclerotic disease.

This is necessary to reduce the vascular and in turn heart, thrombotic, clotting and organ complications of deranged lipid levels. 

Different Kinds of Xanthoma

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All of these different types of xanthomas signify that the disease can present in a variety of ways. However, usually, the primary xanthelasma definition remains true for all. Although the condition itself doesn’t have consequences other than cosmetic problems, you do need to consider the lipid manifestations. The disease requires proper work up to prevent the lipid complications. Plus, the plaque itself can be removed easily.

Xanthelasma Under The Microscope.

Histopathology:

The hallmark histopathologic feature of most xanthomas is the occurrence of foam skin cells within the dermis. These skin cells represent macrophages that have accumulated lipid. These skin cells will stain positive for lipid with special staining (Oil-red-O). According to the location of the plaque and the specific location of the foam cells, a histologic specimen of Xanthelasma can contain striated muscle, hairs or just epidermis.

Skin samples showing the Xanthoma cells.  One of the most common causes of Xanthelasma on the eyelids is in people suffering with both primary and secondary hyperlipidemia (elevated levels of any or all lipids and/or lipoproteins found in the blood).

If you have been diagnosed with altered lipoprotein composition or structure, such as lowered high-density lipoprotein (HDL) levels or type II hyperlipidemia in the type IV phenotype, you are more likely to suffer from Xanthelasma. 

Are Xanthelasma Dangerous?

While the Xanthelasma patches are not harmful themselves, they can be indicative of more serious problems, such as heart disease and high levels of cholesterol. If you do not have a family history of Xanthelasma, they can be an indication of high cholesterol. They might be correlated with a risk of heart disease, and so it is always a good idea to have them examined by your GP to rule out any further problems.

Our Xanthoma / Xanthelasma creams are made to help treat all kinds of xanthoma where ever they appear on the surface of the skin and are made so you can treat your xanthelasma or xanthomas from home. Whilst the norm is to find xanthoma around the eyelids, as we can see from the above images , it can be present in a lot of different areas.  

If you are suffering from xanthoma or Xanthelasma, if you wish, send us clear images of them and we can advise and help you get the best professional treatment available to help remove and stop the ongoing return of your Xanthelasma and eyelid Xanthomas.