Do not ignore yellow plaques on the eyelids

8:15 am Health Care, Medicine

Xanthelasma are soft, cholesterol-filled plaques that develop under the skin, usually on or around the eyelids and most often near the nose. They occur mainly in middle-aged and older adults and in women more often than in men. They are always benign and rarely impair vision. But they can be a sign of hyperlipidemia — elevated blood-fat levels in 50% of the people.

The presence of xanthelasma on the eyelids is an independent predictor of future heart blockages. In a large prospective study By Dr Anne Tybjærg-Hansen, of Rigshospitalet in Copenhagen published in BMJ during a mean follow-up of 22 years, adults participating in a long-term Danish heart study who had xanthelasmata at baseline had an adjusted hazard ratio for acute heart attack of 1.48. In the study those with the eyelid lesions had lower levels of apolipoprotein A1 and HDL cholesterol as against those who had arcus corneae they had higher levels of lipoprotein (a).

The plaques are especially common in people with inherited disorders of low-density lipoprotein (LDL) metabolism. They occur in 75% of older people with familial hypercholesterolemia (very high cholesterol levels) and in 10% of people with high levels of apolipoprotein B.

Treating any underlying lipid condition may reduce the size of xanthelasma. If no lipid abnormality is present then xanthelasma is largely a cosmetic problem.

There are several ways to remove xanthelasma. These include cryotherapy (freezing the lesions with liquid nitrogen), laser ablation, surgical excision, electrodesiccation (destruction of the lesion with an electric needle), and chemical cauterization (application of a topical agent such as trichloroacetic acid to dissolve the plaques).

Take home message

  • All patients with xanthelasmas should get lipid profile done.
  • Look for low HDL and low Apo A1 levels.
  • Look of high Apo B levels.
  • Get LP(a) levels it will usually be normal.

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