Xanthelasma of eyelid - Clinicals, Diagnosis, and Management

Opthalmology

Clinicals - History

Fact Explanation
Aesthetic concerns due to lesion or very rarely disturbance to vision. The typical lesions appear as soft, yellow plaques on the medial aspect of the eyelids. The fatty deposits may also take on a darker red or brown appearance and can vary in texture and firmness.This disorder typically presents in middle-aged and older adults, with an incidence of 1.1 percent in women and 0.3 percent in men. Aesthetic concerns due to lesion or very rarely disturbance to vision.
The typical lesions appear as soft, yellow plaques on the medial aspect of the eyelids. The fatty deposits may also take on a darker red or brown appearance and can vary in texture and firmness.This disorder typically presents in middle-aged and older adults, with an incidence of 1.1 percent in women and 0.3 percent in men.
Chest pain Xanthelasma has been known to be associated with atherosclerosis and coronary artery disease. Chest pain
Xanthelasma has been known to be associated with atherosclerosis and coronary artery disease.
Osmotic symptoms like polyuria and polydipsia. Xanthelasma has been known to be associated with insulin resistance and diabetes mellitus. Osmotic symptoms like polyuria and polydipsia.
Xanthelasma has been known to be associated with insulin resistance and diabetes mellitus.
History of sudden onset paralysis, slurring of speech or any neurological deficit. Xanthelasma has been known to be associated with hypertension and stroke. History of sudden onset paralysis, slurring of speech or any neurological deficit.
Xanthelasma has been known to be associated with hypertension and stroke.
Family history of hypercholesterolaemia or premature atherosclerosis. The appearance of xanthelasma before age 40 may be associated with an increased likelihood of familial hypercholesterolemia. Family history of hypercholesterolaemia or premature atherosclerosis.
The appearance of xanthelasma before age 40 may be associated with an increased likelihood of familial hypercholesterolemia.

Clinicals - Examination

Fact Explanation
Soft, yellow plaques on the medial aspect of the eyelids. Xanthelasmas are composed of xanthoma cells, which are foamy, lipid laden histiocytes. These tend to be found in the superficial dermis in perivascular and periadnexal locations, often with associated surrounding fibrosis and inflammation. Soft, yellow plaques on the medial aspect of the eyelids.
Xanthelasmas are composed of xanthoma cells, which are foamy, lipid laden histiocytes. These tend to be found in the superficial dermis in perivascular and periadnexal locations, often with associated surrounding fibrosis and inflammation.
Tuberous xanthomata and corneal arcus Extensor tendon xanthomas and a corneal arcus are typically associated with xanthelasma. Tuberous xanthomata and corneal arcus
Extensor tendon xanthomas and a corneal arcus are typically associated with xanthelasma.
Blood Pressure Xanthelasma is associated with hypertension. Blood Pressure
Xanthelasma is associated with hypertension.
Measure weight and height and calculate Body Mass Index Xanthelasma is associated with obesity. Measure weight and height and calculate Body Mass Index
Xanthelasma is associated with obesity.

Investigations - Diagnosis

Fact Explanation
Histological examination of biopsy. Usually diagnosis is clinical. But if there is any doubt surgical excision and pathological examination can be done. Microscopically, xanthelasmas are composed of xanthoma cells, which are foamy, lipid-laden histiocytes. These tend to be found in the superficial dermis in perivascular and periadnexal locations, often with associated surrounding fibrosis and inflammation. Histological examination of biopsy.
Usually diagnosis is clinical. But if there is any doubt surgical excision and pathological examination can be done. Microscopically, xanthelasmas are composed of xanthoma cells, which are foamy, lipid-laden histiocytes. These tend to be found in the superficial dermis in perivascular and periadnexal locations, often with associated surrounding fibrosis and inflammation.

Investigations - Management

Fact Explanation
Lipid profile Xanthelasma often indicates an underlying plasma lipid disorder. Hyperlipidemia is reported to occur in approximately 50 percent of patients with xanthelasma. However, xanthelasma can occur in patients with a normolipidemic profile.
Hypertriglyceridemia (triglyceride > 200mg/dl) is the commonest lipid abnormality. Total cholesterol also is expected to be above 240 mg/dl. LDL cholesterol also could be more than 160 mg/dl.
Lipid profile
Xanthelasma often indicates an underlying plasma lipid disorder. Hyperlipidemia is reported to occur in approximately 50 percent of patients with xanthelasma. However, xanthelasma can occur in patients with a normolipidemic profile.
Hypertriglyceridemia (triglyceride > 200mg/dl) is the commonest lipid abnormality. Total cholesterol also is expected to be above 240 mg/dl. LDL cholesterol also could be more than 160 mg/dl.
Fasting blood sugar To exclude diabetes which is associated with xanthelasma. Diabetes is diagnosed if Fasting blood sugar is more than 126 m/dl. Fasting blood sugar
To exclude diabetes which is associated with xanthelasma. Diabetes is diagnosed if Fasting blood sugar is more than 126 m/dl.
Genetic testing (Polymerase Chain Reaction or Western blot for genes LDLR, APOB, PCSK9) The appearance of xanthelasma before age 40 may be associated with an increased likelihood of familial hypercholesterolemia. Genetic testing most commonly involves the three genes LDLR, APOB, and PCSK9, as mutation of one of these genes accounts for approximately 60%-80% of familial hypercholesterolaemia. Genetic testing (Polymerase Chain Reaction or Western blot for genes LDLR, APOB, PCSK9)
The appearance of xanthelasma before age 40 may be associated with an increased likelihood of familial hypercholesterolemia. Genetic testing most commonly involves the three genes LDLR, APOB, and PCSK9, as mutation of one of these genes accounts for approximately 60%-80% of familial hypercholesterolaemia.

Management - Supportive

Fact Explanation
Thyroid hormone replacement In some cases, treatment of the underlying medical disorder can cause regression, as in hypothyroidism. Thyroid hormone replacement
In some cases, treatment of the underlying medical disorder can cause regression, as in hypothyroidism.
Risk modification If hypercholesterolaemia, diabetes or any other risk factor is detected they should be treated to reduce risk of future atherosclerotic disease. However xanthelasma itself is unlikely to undergo regression with that. Risk modification
If hypercholesterolaemia, diabetes or any other risk factor is detected they should be treated to reduce risk of future atherosclerotic disease. However xanthelasma itself is unlikely to undergo regression with that.

Management - Specific

Fact Explanation
Surgical resection If the xanthelasma lesion is smaller than 3 mm and within the range of blepharoplasty
incision, blepharoplasty or modified blepharoplasty can be performed. If the xanthelasma lesion is smaller than 3 mm and outside the range of blepharoplasty
incision, direct elliptical incision can be used. If the xanthelasma lesion is larger than 3 mm, serial excision can be used.
Surgical resection
If the xanthelasma lesion is smaller than 3 mm and within the range of blepharoplasty
incision, blepharoplasty or modified blepharoplasty can be performed. If the xanthelasma lesion is smaller than 3 mm and outside the range of blepharoplasty
incision, direct elliptical incision can be used. If the xanthelasma lesion is larger than 3 mm, serial excision can be used.
Ablation with carbon dioxide laser The advantages of this method are the accurately controlled ablation of thin skin layers, the option for a repeated application
in case of recurrences, the unproblematic and safe treatment in delicate regions of the periorbital area, and the low risk of visible scarring, as well as the low recurrence rate.
Ablation with carbon dioxide laser
The advantages of this method are the accurately controlled ablation of thin skin layers, the option for a repeated application
in case of recurrences, the unproblematic and safe treatment in delicate regions of the periorbital area, and the low risk of visible scarring, as well as the low recurrence rate.
Erbium-YAG This can be used to treat both big and small lesions. Erbium-YAG
This can be used to treat both big and small lesions.
Nd-YAG The Q-switched Nd:YAG (532 and 1,064 nm)
laser treatment of xanthelasma palpebrarum cannot be generally recommended and should be applied with caution.
Nd-YAG
The Q-switched Nd:YAG (532 and 1,064 nm)
laser treatment of xanthelasma palpebrarum cannot be generally recommended and should be applied with caution.
Tricholoracetic acid peels This can be used for small (<3 mm) lesions. Tricholoracetic acid peels
This can be used for small (<3 mm) lesions.

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