Skip to main content
SpringerLink
Log in

Xanthelasma Palpebrarum: More than Meets the Eye

  • Original Article
  • Published:
Indian Journal of Otolaryngology and Head & Neck Surgery Aims and scope Submit manuscript

Abstract

Xanthelasma palpebrarum (XP) is the most common form of cutaneous xanthomata, and is important aesthetically, because of its close relation to the eyes, as well as medically for its association with cardiovascular disease (CVD). To provide avant-garde review discussing the various aspects of XP, including its aetio-pathogenesis and various treatment modalities. A structured Pubmed and Medline were searched for relevant articles. The finding of recent research has strongly espoused the link between XP and CVD, and mechanisms have been suggested for its formation. The new technologies have led to a multitude of treatment options for XP. XP is a multi-faceted entity; other than simple treatment of the cosmetic aspect of the disease, one must be cognizant of its cardiovascular implications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Bergman R (1994) The pathogenesis and clinical significance of xanthelasma palpebrarum. J Am Acad Dermatol 30(2):236–242

    CAS  PubMed  Google Scholar 

  2. Domonkoa AN, Arnold HL Jr., Odom RB (1982) Andrews’ diseases of the skin: clinical dermatology, 7th edn. WB Saunders, Philadelphia, pp 658–660

    Google Scholar 

  3. Jónsson A, Sigfŭsson N (1976) Letter: significance of xanthelasma palpebrarum in the normal population. Lancet 1(7955):372

    PubMed  Google Scholar 

  4. Dequeker J, Muls E, Leenders K (2004) Xanthelasma and lipoma in Leonardo da Vinci’s Mona Lisa. Isr Med Assoc J 6(8):505–506

    PubMed  Google Scholar 

  5. Kim J, Kim YJ, Lim H, Lee SI (2012) Bilateral circular xanthelasma palpebrarum. Arch Plast Surg 39(4):435–437

    PubMed  PubMed Central  Google Scholar 

  6. Sarkany RPE, Breathnach SM, Seymour CA et al (2004) Metabolic and nutritional diseases. In: Burns T, Breathnach S, Cox N et al (eds) Rook’s textbook of dermatology, vol 7. Blackwell, Oxford, p 57.1e57.124

    Google Scholar 

  7. Matsumoto M, Kunimitsu S, Wada K, Ikeda M, Keyama A, Kodama H (2007) Mast cell distribution, activation, and phenotype in xanthoma. J Am Acad Dermatol 56(6):1006–1012

    PubMed  Google Scholar 

  8. Parker F, Odland GF (1968) Experimental xanthoma. A correlative biochemical, histologic, histochemical, and electron microscopic study. Am J Pathol 53(4):537–565

    CAS  PubMed  PubMed Central  Google Scholar 

  9. Parker F, Peterson N, Odland GF (1966) A comparison of cholesterol-ester fatty acid patterns in the blood and in evolving xanthoma and atheroma during cholesterol-feeding of rabbits. J Invest Dermatol 47(3):253–259

    CAS  PubMed  Google Scholar 

  10. Watanabe A, Yoshimura A, Wakasugi T et al (1981) Serum lipids, lipoprotein lipids and coronary heart disease in patients with xanthelasma palpebrarum. Atherosclerosis 38:283–290

    CAS  PubMed  Google Scholar 

  11. Ribera M, Pinto X, Argimon JM et al (1995) Lipid metabolism and apolipoprotein-E phenotypes in patients with xanthelasma. Am J Med 99:485–490

    CAS  PubMed  Google Scholar 

  12. Gómez JA, Gónzalez MJ, de Moragas JM, Serrat J, Gónzalez-Sastre F, Pérez M (1988) Apolipoprotein E phenotypes, lipoprotein composition, and xanthelasmas. Arch Dermatol 124(8):1230–1234

    PubMed  Google Scholar 

  13. Montgomery H, Osterberg A (1938) Xanthomatosis: correlation of clinical, histopathologic, and chemical studies of cutaneous xanthoma. Arch Dermatol 37:373–401

    Google Scholar 

  14. Vacca JB, Knight WA, Broun GO (1959) Clinical observations regarding xanthelasma. Ann Intern Med 51:1019–1031

    CAS  PubMed  Google Scholar 

  15. Epstein NN, Rosenmann RH, Gofman JW (1952) Serum lipoproteins and cholesterol metabolism in xanthelasma. Arch Dermatol 65:70–81

    CAS  Google Scholar 

  16. Pedace JF, Winkelmann RK (1965) Xanthelasma palpebrarum. J Am Med Assoc 193:893–894

    CAS  Google Scholar 

  17. Bergman R (1998) Xanthelasma palpebrarum and risk of atherosclerosis. Int J Dermatol 37(5):343–345

    CAS  PubMed  Google Scholar 

  18. Bergman R, Kasif Y, Aviram M, Maor I, Ullman Y, Gdal-On M, Friedman-Birnbaum R (1996) Normolipidemic xanthelasma palpebrarum: lipid composition, cholesterol metabolism in monocyte-derived macrophages, and plasma lipid peroxidation. Acta Derm Venereol 76(2):107–110

    CAS  PubMed  Google Scholar 

  19. Douste-Blazy P, Marcel YL, Cohen L, Giroux JM, Davignon J (1982) Increased Frequency of Apo E-ND phenotype and hyperapobeta-lipoproteinemia in normolipidemic subjects with xanthelasmas of the eyelids. Ann Intern Med 96(2):164–169

    CAS  PubMed  Google Scholar 

  20. Greenland P, Abrams J, Aurigemma GP et al (2000) Prevention conference V: beyond secondary prevention: identifying the high-risk patient for primary prevention: non-invasive tests of atherosclerotic burden—Writing Group III. Circulation 101:E16e22

    Google Scholar 

  21. Noël B (2007) Premature atherosclerosis in patients with xanthelasma. J Eur Acad Dermatol Venereol 21(9):1244–1248

    PubMed  Google Scholar 

  22. Pandhi D, Gupta P, Singal A, Tondon A, Sharma S, Madhu SV (1038) Xanthelasma palpebrarum: a marker of premature atherosclerosis (risk of atherosclerosis in xanthelasma). Postgrad Med J 2012(88):198–204

    Google Scholar 

  23. Akyuz AR, Turan T, Erkus ME, Gurbak KS et al (2016) Xanthelasma palpebrarum associated with increased cardio-ankle vascular index in asymptomatic subjects. Wien Klin Wochenschr 128(suppl 8):610–613

    PubMed  Google Scholar 

  24. Bhat J, Smith AG (2003) Xanthelasma palpebrarum following allergic contact dermatitis from para-phenylenediamine in a black eyelash-tinting product. Contact Dermat 49(6):311

    CAS  Google Scholar 

  25. Platsidaki E, Kouris A, Agiasofitou E, Antoniou C, Kontochristopoulos G (2016) Periorbital hyperpigmentation in patients with xanthelasma palpebrarum :an interesting observation. J Clin Aesthet Dermatol 9(4):52–54

    PubMed  PubMed Central  Google Scholar 

  26. D’Acunto C, Pazzaglia M, Raone B, Misciali C, Badiali L, Neri I, Patrizi A (2013) Xanthelasma palpebrarum: a new adverse reaction to intradermal fillers? Br J Dermatol 168(2):437–439

    PubMed  Google Scholar 

  27. Başterzi Y, Sari A (2006) Xanthelasma palpebrarum after septorhinoplasty. Aesthetic Plast Surg 30(4):492–493

    PubMed  Google Scholar 

  28. Scott PJ, Winterbourn CC (1967) Low-density lipoprotein accumulation in actively growing xanthomas. J Atheroscler Res 7(2):207–223

    CAS  PubMed  Google Scholar 

  29. Seike M, Ikeda M, Matsumoto M, Hamada R, Takeya M, Kodama H (2006) Hyaluronan forms complexes with low density lipoprotein while also inducing foam cell infiltration in the dermis. J Dermatol Sci 41(3):197–204

    CAS  PubMed  Google Scholar 

  30. Sayin L, Ayli M, Oguz AK, Sevel GC (2016) Xanthelasma palpebrarum: a new side effect of nilotinib. BMJ Case Rep. https://doi.org/10.1136/bcr-2015-213511

    Article  PubMed  PubMed Central  Google Scholar 

  31. Karsai S, Czarnecka A, Raulin C (2010) Treatment of xanthelasma palpebrarum using a pulsed dye laser: a prospective clinical trial in 38 cases. Dermatol Surg 36(5):610–617

    CAS  PubMed  Google Scholar 

  32. Parkes ML, Waller TS (1984) Xanthelasma palpebrarum. Laryngoscope 94(9):1238–1240

    CAS  PubMed  Google Scholar 

  33. Lee HY, Jin US, Minn KW, Park Y-O (2013) Outcomes of surgical management of xanthelasma palpebrarum. Arch Plast Surg 40:380–386

    PubMed  PubMed Central  Google Scholar 

  34. Kose R (2013) Treatment of large xanthelasma palpebrarums with full-thickness skin grafts obtained by blepharoplasty. J Cutan Med Surg 17(3):197–200

    PubMed  Google Scholar 

  35. Roberts HL (1926) The Chloroacetic acids: a biochemical study. Br J Dermatol 38:323–391

    Google Scholar 

  36. Haygood LJ, Bennett JD, Brodell RT (1998) Treatment of xanthelasma palpebrarum with bichloracetic acid. Dermatol Surg 24(9):1027–1031

    CAS  PubMed  Google Scholar 

  37. Cannon PS, Ajit R, Leatherbarrow B (2010) Efficacy of trichloroacetic acid (95%) in the management of xanthelasma palpebrarum. Clin Exp Dermatol 35(8):845–848

    CAS  PubMed  Google Scholar 

  38. Haque MU, Ramesh V (2006) Evaluation of three different strengths of trichloroacetic acid in xanthelasma palpebrarum. J Dermatol Treat 17(1):48–50

    CAS  Google Scholar 

  39. Nahas TR, Marques JC, Nicoletti A, Cunha M, Nishiwaki-Dantas MC, Filho JV (2009) Treatment of eyelid xanthelasma with 70% trichloroacetic acid. Ophthalmic Plast Reconstr Surg 25(4):280–283

    PubMed  Google Scholar 

  40. Dincer D, Koc E, Erbil AH, Kose O (2010) Effectiveness of low-voltage radiofrequency in the treatment of xanthelasma palpebrarum: a pilot study of 15 cases. Dermatol Surg 36(12):1973–1978

    CAS  PubMed  Google Scholar 

  41. Dawber R, Colver G, Jackson A, Pringle F (1992) Cutaneous cryosurgery. Principles and Clinical practice. Martin Dunitz, London

    Google Scholar 

  42. Kuflik EG, Gage AA (1990) Cryosurgical treatment of skin cancer. Igaku-Shoin, Newyork

    Google Scholar 

  43. Sheperd J, Dawber RP (1982) The historical and scientific basis of cryosurgery. Clin Exp Dermatol 7:321–328

    Google Scholar 

  44. Dewan SP, Kaur A, Gupta RK (1995) Effectiveness of cryosurgery in xanthelasma palpebrarum. Indian J Dermatol Venereol Leprol 61(1):4–7

    CAS  PubMed  Google Scholar 

  45. Labandeira J, Vázquez-Osorio I, Figueroa-Silva O, Pereiro M Jr, Toribio J (2015) Tolerability and effectiveness of liquid nitrogen spray cryotherapy with very short freeze times in the treatment of xanthelasma palpebrarum. Dermatol Ther 28(6):346–350

    PubMed  Google Scholar 

  46. Delgado Navarro C, Lanuza García A, Llorca Cardeñosa A, Bañón-Navarro R, Corchero MG (2013) Application of laser CO2 for the treatment of xanthelasma palpebrarum. Arch Soc Esp Oftalmol 88:320–322

    CAS  PubMed  Google Scholar 

  47. Raulin C, Schoenermark MP, Werner S, Greve B (1999) Xanthelasma palpebrarum: treatment with the ultrapulsed CO2 laser. Lasers Surg Med 24(2):122–127

    CAS  PubMed  Google Scholar 

  48. Pathania V, Chatterjee M (2015) Ultrapulse carbon dioxide laser ablation of xanthelasma palpebrarum: a case series. J Cutan Aesthet Surg 8(1):46–49

    PubMed  PubMed Central  Google Scholar 

  49. Saif MYS (2007) Xanthelasma palpebrarum treatment by CO2 laser. Bull Ophthalmol Soc Egypt 100:791–794

    Google Scholar 

  50. Esmat SM, Elramly AZ, Abdel Halim DM, Gawdat HI, Taha HI (2014) Fractional CO2 laser is an effective therapeutic modality of xanthelasma palpebrarum: a randomized clinical trial. Dermatol Surg 40(20):1349–1355

    CAS  PubMed  Google Scholar 

  51. Borelli C, Kaudewitz P (2001) Xanthelasma palpebrarum: treatment with the erbium:YAG laser. Lasers Surg Med 29(3):260–264

    CAS  PubMed  Google Scholar 

  52. Mannino G, Papale A, De Bella F, Mollo R (2001) Use of Erbium:YAG laser in the treatment of palpepral xanthelasmas. Opthalmic Surg Lasers 32:129–133

    CAS  Google Scholar 

  53. Kaufmann R, Hibst R (1996) Pulsed Erbium-YAG laser ablation in cutaneous surgery. Lasers Surg Med 19:324–330

    CAS  PubMed  Google Scholar 

  54. Drnovsek-Olup B, Vedlin B (1997) Use of Erbium:YAG laser for benign skin disorders. Lasers Surg Ned 21:13–19

    Google Scholar 

  55. Levy JL, Trelles MA (2003) New operative technique for treatment of xanthelasma palpebrarum: laser-inverted resurfacing: preliminary report. Ann Plast Surg 50(4):339–343

    PubMed  Google Scholar 

  56. Anderson RR, Margolis RJ, Watenabe S, Flotte T, Hruza GJ, Dover JS (1989) Selective photothermolysis of cutaneous pigmentation by Q-switched Nd: YAG laser pulses at 1064, 532, and 355 nm. J Invest Dermatol 93(1):28–32

    CAS  PubMed  Google Scholar 

  57. Fusade T (2008) Treatment of xanthelasma palpebrarum by 1064-nm Q-switched Nd: YAG laser: a study of 11 cases. Br J Dermatol 158(1):84–87

    CAS  PubMed  Google Scholar 

  58. Karsai S, Schmitt L, Raulin C (2009) Is Q-switched neodymium-doped yttrium aluminium garnet laser an effective approach to treat xanthelasma palpebrarum? Results from a clinical study of 76 cases. Dermatol Surg 35(12):1962–1969

    CAS  PubMed  Google Scholar 

  59. Marini L (2013) 1064 nm Q-switched photo-acoustic laser ablation of xanthelasma palpebrarum. J Laser Health Acad 1:48–51

    Google Scholar 

  60. Berger C, Kopera D (2005) KTP laser coagulation for xanthelasma palpebrarum. J Dtsch Dermatol 3(10):775–779

    Google Scholar 

  61. Greijmans E, Luiting-Welkenhuyzen H, Luijks H, Bovenschen HJ (2016) Continuous wave potassium titanyl phosphate laser treatment is safe and effective for xanthelasma palpebrarum. Dermatol Surg 42(7):860–866

    CAS  PubMed  Google Scholar 

  62. Schönermark MP, Raulin C (1996) Treatment of xanthelasma palpebrarum with the pulsed dye laser. Lasers Surg Med 19(3):336–339

    PubMed  Google Scholar 

  63. Astner S (2009) Clinical applicability of a 1 450 nm diode laser as adjunctive treatment for refractory acne. G Ital Dermatol Venereol 144(6):629–638

    CAS  PubMed  Google Scholar 

  64. Friedman PM, Jih MH, Kimyai-Asadi A, Goldberg LH (2004) Treatment of inflammatory facial acne vulgaris with the 1450-nm diode laser: a pilot study. Dermatol Surg 30(2 Pt 1):147–151

    PubMed  Google Scholar 

  65. No D, McClaren M, Chotzen V, Kilmer SL (2004) Sebaceous hyperplasia treated with a 1450-nm diode laser. Dermatol Surg 30(3):382–384

    PubMed  Google Scholar 

  66. Chua SH, Ang P, Khoo LS, Goh CL (2004) Nonablative 1450-nm diode laser in the treatment of facial atrophic acne scars in type IV to V Asian skin: a prospective clinical study. Dermatol Surg 30(10):1287–1291

    PubMed  Google Scholar 

  67. Park EJ, Youn SH, Cho EB, Lee GS, Hann SK, Kim KH, Kim KJ (2011) Xanthelasma palpebrarum treatment with a 1450-nm-diode laser. Dermatol Surg 37(6):791–796

    CAS  PubMed  Google Scholar 

  68. Shields CL, Mashayekhi A, Shields JA (2005) Disappearance of eyelid xanthelasma following oral simvastatin (Zocor). Br J Ophthalmol 89:639–645

    CAS  PubMed  PubMed Central  Google Scholar 

  69. Wang H, Shi Y, Guan H, Liu C, Zhang W et al (2016) Treatment of xanthelasma palpebrarum with intralesional pingyangmycin. Dermatol Surg 42(3):368–376

    CAS  PubMed  Google Scholar 

  70. Mourad B, Elgarhy LH, Ellakkawy HA, Elmahdy N (2015) Assessment of efficacy and tolerability of different concentrations of trichloroacetic acid vs. carbon dioxide laser in treatment of xanthelasma palpebrarum. J CosmetDermatol 14(3):209–215

    Google Scholar 

  71. Goel K, Sardana K, Garg VK (2015) A prospective study comparing ultrapulse CO2 laser and trichloroacetic acid in treatment of Xanthelasmapalpebrarum. J Cosmet Dermatol 14(2):130–139

    PubMed  Google Scholar 

  72. Abdelkader M, Alashry SE (2015) Argon laser versus erbium:YAG laser in the treatment of xanthelasma palpebrarum. Saudi J Ophthalmol 29(2):116–120

    PubMed  Google Scholar 

  73. Güngör S, Canat D, Gökdemir G (2014) Erbium:YAG laser ablation versus 70% trichloroacetıc acid application in the treatment of xanthelasma palpebrarum. J Dermatol Treat 25(4):290–293

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Otolaryngology – Head and Neck Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Yishun, 768828, Singapore

    Shailesh Khode, Soon Heng Terry Tan, En-Pei Amanda Tan & Sandeep Uppal

Authors
  1. Shailesh Khode
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Soon Heng Terry Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. En-Pei Amanda Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandeep Uppal
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shailesh Khode.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khode, S., Tan, S.H.T., Tan, EP.A. et al. Xanthelasma Palpebrarum: More than Meets the Eye. Indian J Otolaryngol Head Neck Surg 71 (Suppl 1), 439–446 (2019). https://doi.org/10.1007/s12070-018-1345-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12070-018-1345-0

Keywords

Search

Navigation