Xanthelasma
𝘠𝘦𝘭𝘭𝘰𝘸 𝘭𝘪𝘥𝘴!
Benign cutaneous lesions around the periocular area
More common in women
30-50 years of age
Associated lipid disorders
Risk factors
Diabetes mellitus
Hypothyroidism
Cardiovascular disease
Obesity
Pancreatitis
Hyperuricemia
Smokers
Excessive alcohol intake
Pathophysiology
Increased plasma peroxidation of low density lipoprotein (LDL) resulting in cholesterol accumulation within macrophages to form foam cells
In xanthoma formation, the ability to remove cholesterol from the tissue is reduced due to low HDL levels
The rate at which LDL leaks from the capillaries is increased in areas that have more friction and are in constant motion (so eyelid skin is most commonly affected)
An increase in inflammatory cells within the eyelid tissue is also thought to have an effect on the formation of xanthelasma
Features:
Most common site: Medial canthus. More in upper lid
Soft, yellow papules or plaques filled with cholesterol
Multiple, symmetric lesions
HPE:
Reticular dermis infiltration of foamy macrophages with sparing of the epidermis, papillary dermis, and subcutaneous fatty layer
Inflammatory infiltrate in the superficial reticular dermis will be perivascular and consist of foam cells with lipid-laden cytoplasmic vacuoles
Systemic Investigations
HbA1C
LFT
Thyroid function tests
Lipid profile
Rx
Conservative: Low-fat diet, Statins
Surgical excision
Laser therapy: Coagulates vessels and damages the perivascular foam cells that
make up the lesion. Fractionated Er:YAG and fractionated CO2 lasers are used
Chemical peel: With Tricholoroacetic acid (70% concentration)
Peel induces a chemical cauterization causing coagulation of proteins within the
skin- this is then neutralized within the superficial dermal plexus
Effective on small lesions
Cryotherapy: causes vasoconstriction and the formation of microthrombi as a result of cell death within XP lesions Now avoided because of high risk of eyelid swelling.
Radiofrequency ablation: electrocoagulation for instant hemostasis and is used in vascular lesions. For lesions that are very close to the globe or have indistinct borders.
www.ophthalmobytes.com
Image from Rajan Eye Care Hospital
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