What is xanthelasma?

Xanthelasma
Definition: xanthomatous inflammation of the eyelid.
Incidence/Prevalence: Xanthelasma is the most common form of xanthoma of the skin. Xanthelasma tends to manifest in middle-aged to elderly individuals, predominantly females, but can be seen over a wide age range and children have been reported with the lesions.
Etiology: Xanthelasma has been associated with hyperlipoproteinemic states. All types of hyperlipoproteinemia including secondary forms have been linked to xanthelasma but types II and III, are present in 30%-40% of patients with xanthelasma. Some have argued that xanthelasma was a harbinger of premature death of the subject in the DeVinci painting (Mona Lisa).
Clinical Findings: Lesions are usually bilateral but may be single. Soft yellow plaques are located in the nasal aspect of the upper and lower eyelids.
Histopathology: Sections show collections of histiocytes with microvesicular foamy cytoplasm (arrow 1) clustered around vessels and adnexal structures within the dermis without significant numbers of accompanying lymphocytes or other inflammatory cells.





















At higher magnification cells with bean shaped nuclei contain foamy cytoplasm that is quite distinct (light arrow). Examination of adjacent cells demonstrates similar foamy histiocytes with a paucity of other inflammatory cells.
Treatment: The lesions are benign and removal is generally for cosmetic purposes and rarely for diagnosis. The lesions are usually surgically excised. Recently reports indicate that treatment with statin agents result in the disappearance of xanthelasma lesions. Steroids have been injected in the lesion. Carbon dioxide laser and topical trichloroacetic acid in various concentrations have been used to ablate xanthelasma.
Prognosis: Recurrence is quite common, almost 50% after surgical excision.

Reference:
Shields CL et al. Disappearance of eyelid xanthelasma following oral simvastatin (Zocor). Br J Ophthalmol 2005; 89:639-40.