Description, Causes and Risk Factors:
Xanthelasma palpebrarum is a disorder affecting eyelids with symmetrical soft, yellowish brown velvety papules on the inner canthi (either of the corners of the eye where the upper and lower eyelids meet) of upper and lower lids. These have a tendency to be multiple, progressive, permanent and coalescent. Though it is a benign lesion causing no functional disturbance, it is aesthetically annoying. Adults are more prone to xanthelasma palpebrarum when compared to children.
Xanthelasma is not cancerous but can be associated with the condition of excess fat in the blood "hypercholesterolemia". This can be associated with heart disease and so someone with a xanthelasma should have their cholesterol level checked.
The exact cause is not known but several factors like lipid abnormalities hormonal factors, local factors and macrophages are attributed to play a role in its etiopathogenesis. Recently the role of acetylated LDL and macrophages with their scavenger receptors has been observed in the causation of xanthelasma palpebrarum.
Xanthelasma palpebrarum are composed of xanthoma cells which are foamy histiocytes laden with intracellular fat deposits primarily within the upper reticular dermis. The main lipid that is stored in both the hyperlipidemic and normolipidemic xanthelasma is esterified cholesterol. The predominant lipid accumulated in normolipidemic xanthelasmic lesions is cholesteryl ester, but there is no evidence for intrinsic cellular cholesterol metabolism derangement in blood monocyte derived macrophages from patients which could account for this. Since macrophage cholesterol accumulation can also result from enhanced uptake of increased levels of oxidized LDL, the increased plasma lipid peroxidation (derived from oxidized LDL) might lead to accumulation of cholesterol in macrophages and formation of foam cells via this mechanism.
Xanthelasma appears as a yellow-to-orange patch or bump. Ranging in size from 2-30 mm, xanthelasma is flat-surfaced and has distinct borders (well-defined).
Xanthelasma is usually not itchy or tender. Individuals with xanthelasma are usually most concerned with their cosmetic appearance.
After a certain time, these patches either enlarge or tend to decrease.
Sometimes, the person affected with this disease, may find it difficult to shut his eyes completely, as these patches enlarge.
Sometimes due to muscle paralysis or even weakness, the upper eyelid droops.
The most common locations for xanthelasma include: #1 one or both upper eyelids, especially near the nose, #2 one or both lower eyelids.
To confirm your diagnosis of xanthelasma, the doctor may want to perform a skin biopsy. The procedure involves:
Sampling a small piece of skin by using a flexible razor blade, a scalpel, or a tiny cookie cutter (called a "punch biopsy"). If a punch biopsy is taken, a stitch (suture) or two may be placed and will need to be removed 6-14 days later.
Having the skin sample examined under the microscope by a specially trained physician (dermatopathologist) the disease gets diagnosed.
Numbing the skin with an injectable anesthetic.
Liquid nitrogen is used by the doctors to dissolve the fat. Application of a specially formulated acetic acid solution also uses to dissolve the xanthelasma.
If the reason of the illness is due to increased cholesterol, the doctor may recommend the patient a controlled diet. Fatty foods should be avoided so as to decrease the cholesterol levels. Medicines can also be prescribed to reduce excess lipids.
In few cases, laser therapy, surgical excision, and electric needle treatment can also be used to get rid of the patches.
In few cases, xanthelasma disappears without any medications or treatment.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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