Xanthelasma H02.6

Author: Prof. Dr. med. Peter Altmeyer

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Last updated on: 29.10.2020

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Synonym(s)

Lidxanthelasma; Lidxanthelasmas; Lidxanthome; plane xanthomes of the eyelids; Xanthelasma; Xanthelasma of the eyelids; Xanthelasma palpebrarum

History
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Rayer, 1835; Addison and Gull, 1850

Definition
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Plane, in the area of the upper and lower eyelids localized xanthomas. The term "xanthelasma" was also used in older literature for plane xanthomas not localized at the eyelids (see index).

Etiopathogenesis
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Mostly idiopathic, rarely symptomatic of hyperlipoproteinaemia type III and hyperlipoproteinaemia type II, rarely familial.

Manifestation
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Age at first appearance of the planar xanthomas of the eyelids: 40-60 years. m>w.

Clinical features
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0.1-2.0 cm large, white-yellow, flat, rarely knotty, soft, oval, but also stripy spots or plaques, papules or knots with a smooth surface. In larger studies associations are found with dyslipidemia (60%), hypertension (40%), diabetes mellitus (18%).

Histology
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Accumulation of foam cells (storage of lipids) in the upper and middle corium, more rarely giant touton cells. In HE-section lipids not stained (vacuoles); visualization by means of Sudan staining.

Therapy
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Control of cholesterol/LDL (hypercholesterolemia type II and III according to Fredrickson) and triglycerides. Treatment of the metabolic disorder, if present. As an alternative method for isolated xanthelasmas, a single dab with trichloroacetic acid R267 has been described (coagulation necrosis).

Operative therapie
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  • Removal by electrocautery, if necessary under local anaesthetic. Practical procedure: Fix and tighten the eyelid by an assistant. Using the stably guided masticatory needle, pierce the xanthelasm to a depth of about 1 mm and apply a short current pulse of medium intensity. The current causes focal destruction of the fat-storing macrophages, leakage of free fat into the tissue and induction of granulation tissue with degradation of the damaged or destroyed fat-storing cells. Set current marks at intervals of 2-3 mm! Cave! By leaving bridges of intact skin spaces, extensive necroses are avoided. Good cosmetic end result.
  • After the procedure, largely dry wound treatment, if necessary disinfecting external agents, e.g. polyvidon iodine ointment (e.g. Betaisodona). The cautery-induced inflammatory reaction subsides after 3-4 weeks, cautery scars are almost not visible after healing. If residuals are still present, cauterization should be repeated. Principle: It is better to carefully chew several times than to place a large necrosis once!
  • Instead of cauterization, lasers (e.g. Erbium-YAG-Laser) can be used. In this case, an analogous principle to that used in cautery surgery is followed by setting energy-defined laser marks at intervals of 2-3 mm (energy: 600-700 mJ/cm2, focus-skin distance = 1.5-2.0 cm, diameter of the laser beam: 1.0-1.5 mm).
  • When ablating with curettage, the aim is to curet the xanthelasma flat. The procedure requires long personal experience and great tactile skills (only possible with a helper who fixes the eyelid tightly).
  • Smaller xanthelasma can also be excised in a narrow-spindle manner. The scar conditions in the eyelid area are generally very satisfactory with a good surgical technique.

Progression/forecast
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No spontaneous regression, arteriosclerosis and consequences of hyperlipoproteinemia.

Note(s)
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In the so-called Copenhagen Heart Study (12,745 adult Danes, 33 years old) it was shown that carriers of xanthelasma also have an increased cardiovascular risk when other risk factors such as age, sex, cholesterol and triglyceride levels, body mass index, hypertension, diabetes, smoking, alcohol and lack of exercise were taken into account. According to the adjusted analysis, xanthelasma increases the risk of heart attack by 48%. The risk of ischaemic heart disease increases by 39 %, the risk of death by 14 % (Christoffersen et al. 2011)

It can be assumed that xanthelasma is not only an indicator of hypercholesterolemia. It is possible that these patients have a tendency to deposit cholesterol in the tissues, not only in the skin but also in the blood vessels (in this case the formation of atherosclerotic plaques) or in the iris of the eye (here: Arcus senilis).

Literature
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  1. Apfelberg DB et al (1987) Treatment of xanthelasma palpebrarum with the carbon dioxide laser. J Dermatol Surg Oncol 13: 49-51
  2. Borelli C et al (2001) Xanthelasma palpebrarum: treatment with the erbium:YAG laser. Lasers Surg Med 29: 260-264
  3. Christoffersen M et al (2011) Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study. BMJ 343:d5497
  4. Dey A et al (2013) Cardiovascular profile of xanthelasmapalpebrarum
    . Biomed Res Int doi: 10.1155/2013/932863.

  5. Lee MW et al (2003) Extensive xanthelasma associated with anaplastic large cell lymphoma and hyperimmunoglobulin E syndrome. Int J Dermatol 42: 944-946
  6. Ronnen M et al (1989) Treatment of xanthelasma with Solcoderm. J Am Acad Dermatol 21: 807-809
  7. Rose EH et al (1987) Unilaterally invasive xanthelasma palpebrarum. Ophthal Plast Reconstr Surgery 3: 91-94

Disclaimer

Please ask your physician for a reliable diagnosis. This website is only meant as a reference.

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Last updated on: 29.10.2020