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Xanthelasma

Xanthelasma

Introduction to Xanthelasma

Xanthelasma is a common condition usually, affecting the middle-aged and elderly individuals. It is a sub-type of Xanthoma. It usually found in 1/3rd of the patients, where the corneal arcus may be present. In contrast to the Chalazion, fat in Xanthelasma is mainly intracellular with lipid-laden histiocytes in the dermis.

Xanthelasma
Xanthelasma

Causes

There are many cause which are listed below

  • Genetic Cause
    • Deficiency of familial lipoprotein lipase.
    • Familial hypertriglyceridemia, a genetic condition that causes people to have higher amount of triglycerides in the blood
    • familial dyslipoproteinemia, a genetic condition that causes people to have higher amount of lipids in the blood
  • Lifestyle
    • Diets with high saturated fats and low unsaturated fats
    • excess alcohol
    • lack of cardiovascular excercise
    • weight gain
    • Diet with low fiber
    • Smoking
  • Medications
    • beta-blockers
    • oral contraceptives
    • estrogen-containing medications
    • corticosteroids
    • retinoids
    • thiazide diuretics
    • protease inhibitors
    • anabolic steroids
    • antiepileptic drugs

Risk Factors

Anyone can get this but more risk are to

  • Women
  • Age between 30-50
  • Smoker
  • Obese
  • High Blood Pressure
  • Diabetic
  • High lipid levels

Diagnosis

Usually they are yellowish subcutaneous plaques in the medial aspects of the eyelids. Commonly, they are bilateral and are multiple. Because of the distinctive appereance, your doctor may be able to diagnose from the visual exam. They may want to look for some risk factor like diet and genetics. Some of them do the blood panel test to determine the lipid levels. This measures the HDL and LDL cholestrol, triglyceride and apolipoprotein B100 levels. Also, the test will verify if the cause of xanthelasma is due to elevated lipoprotein levels.

Treatment of Xanthelasma

This is principally for cosmesis. Recurrence occurs in up to 50%, and is most common in patients with hypercholesterolaemia.

  • Simple excision is common one where adequate excess skin is present, which is a traditional one.
  • Cryotherapy is a process to freeze the Xanthelasma with liquid nitrogen or other chemical.
  • Microdissection. First of all Larger lesions is raised in a flap. And the fatty deposits dissected from overlying skin under a surgical microscope using microscissors, and finally the skin replaced.
  • Other methods. Chemical peeling with bi- or trichloroacetic acid can yield good result. Laser ablation and cryotherapy have advantages but may be more prone to scarring, including pigmentary changes

Reference : Kanskis Clinical Opthalmology, A Systematic Approach by Brad Bowling

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