Xanthelasma 49-Year-Old Woman

A 49-year-old woman noticed a growing lesion near the inner corner of her left upper eyelid. The lesion had become conspicuous because of its size and color; the patient wanted it removed.

This is a xanthelasma, or xanthoma palpebrarum, a lesion that often occurs bilaterally. Xanthelasma frequently occur in women during the fourth and fifth decades of life and are common among elderly persons of both sexes.

The elevated, yellow, plaquelike lesions typically appear just beneath the skin surface (A). Most often, they erupt on the medial portion of the eyelid. Xanthelasma are filled with cholesterol and other lipids that infiltrate xanthoma cells.

Cosmetic appearance may be a consideration; however, the major concerns in patients with xanthelasma are the potential complications of associated atherosclerotic cardiovascular diseases and possible systemic disorders, such as diabetes mellitus and cirrhosis.¹ Between 30% and 50% of younger patients (aged 30 to 55 years) with these lesions have a disturbance of lipid metabolism.²

This patient's serum lipid profile showed no abnormalities. Treatment options included excision, vaporization with a carbon dioxide laser, and chemical cauterization with dichloroacetic acid. The patient chose the last procedure because it could be performed simply and relatively inexpensively in the office. Dichloroacetic acid is a strong cauterant and keratolytic agent that causes little scarring and often leaves hair follicles intact.

The acid is applied directly to the lesion, covering it completely. The xanthelasma immediately turns white, becomes sticky, and appears to melt (B). Over the next few days, the treated surface darkens and an eschar forms. The slough falls off after 1 or 2 weeks, leaving mildly injected tissue that soon returns to normal color (C).

Explain to the patient that these lesions can recur despite removal by surgery or chemical cautery.

REFERENCES:1. Parkes ML, Waller TS. Xanthelasma palpebrarum. Laryngoscope. 1984;94:1238-1240.
2. Douste-Blazy P, Marcel YL, Cohen L, et al. Increased frequency of Apo E-ND phenotype and hyperapobeta lipoproteinemia in normolipidemic subjects with xanthelasmas of the eyelid. Ann Intern Med. 1982;96:164-169.