Xanthelasma is a common dermatological condition characterised by yellowish plaques that develop on the skin around the eyelids. These plaques are made up of cholesterol deposits and can sometimes be a sign of an underlying health issue, which is why a medical review is an important first step. This article explains what xanthelasma is, its causes, symptoms, diagnosis and the treatment options that may be considered.
What is Xanthelasma?
Xanthelasma palpebrarum is a condition in which fatty deposits accumulate under the skin, primarily around the eyes. These deposits appear as soft, yellowish plaques and are often symmetrical. While xanthelasma itself is benign and not harmful, it can be a cosmetic concern for many people — and, importantly, it can be associated with cholesterol or lipid problems that are worth investigating.
Causes of Xanthelasma
Xanthelasma is often associated with disorders of lipid (fat) metabolism, but it can also occur in people with normal cholesterol levels. Common associations include:
- High cholesterol: elevated levels of low-density lipoprotein (LDL) cholesterol can be linked to xanthelasma.
- Hyperlipidaemia: a condition in which there are high levels of lipids (fats) in the blood.
- Genetic factors: a family history of xanthelasma or hyperlipidaemia can increase the likelihood.
- Other health conditions: conditions such as diabetes, liver disease and an underactive thyroid (hypothyroidism) can also be associated with xanthelasma.
Because xanthelasma can be a marker of these conditions, it is sensible to see your doctor for a check of your cholesterol and general health, regardless of whether you decide to have the plaques treated cosmetically.
Symptoms of Xanthelasma
The main feature of xanthelasma is the appearance of yellowish plaques on the eyelids. These plaques tend to have distinct characteristics:
Colour
Pale yellow to orange.
Texture
Soft, and flat or slightly raised.
Location
Typically found on the upper and lower eyelids, often near the inner corners of the eyes.
Size and Shape
They vary in size from a few millimetres to several centimetres and often appear in a symmetrical pattern.
Diagnosis of Xanthelasma
Diagnosing xanthelasma usually involves a physical examination by a doctor. The appearance of the plaques is often distinctive enough for a diagnosis. Because xanthelasma can be linked to underlying conditions, further tests are commonly recommended:
Lipid Profile Test
Measures cholesterol levels and other fats in the blood.
Blood Sugar Test
Checks for diabetes or prediabetes.
Liver Function Test
Evaluates liver health, as liver conditions can be associated with xanthelasma.
Treatment Options for Xanthelasma
Because xanthelasma can be a sign of high cholesterol or another lipid or metabolic condition, the first step is a medical review with your doctor — not just cosmetic removal. Where the plaques are treated for cosmetic reasons, the options below may be considered. Xanthelasma can recur after any treatment, sometimes more than one session is needed, and results, downtime and risks vary from person to person and are assessed individually beforehand.
1. Medications
Cholesterol-lowering medicines such as statins or fibrates, prescribed and managed by your doctor, can help manage high cholesterol and may reduce the likelihood of further plaques developing. These treat the underlying lipid issue rather than removing existing plaques.
2. Excision
Physical removal of the plaques can be carried out under local anaesthetic by an appropriately qualified medical practitioner. This is a medical procedure that MedAesthetics — as a non-surgical clinic — does not provide; if it is being considered, your GP can advise on referral.
3. CO2 or Erbium:YAG Laser
Laser treatment uses focused energy to break down and remove the cholesterol deposits. It can be effective for some people, but results — and the amount of any residual redness or scarring — vary between individuals. Possible risks include redness, changes in pigmentation (particularly in darker skin) and scarring, which are discussed at consultation.
4. Chemical Peels
Trichloroacetic acid (TCA) peels work by causing the top layers of skin to peel off, which can take the plaques with them. Peels carry risks such as stinging, redness, pigment change and, less commonly, scarring, and more than one treatment may be needed.
5. Cryotherapy
This method involves freezing the plaques with liquid nitrogen so they gradually come away over time. It is generally less precise than laser treatment and carries a risk of pigment change, particularly in darker skin.
6. Radiofrequency Treatment (Electrodesiccation)
This technique uses radiofrequency energy to heat and break down the cholesterol deposits so the plaques can be removed.
Whether any of these options is suitable for you, and what result and recovery are realistic, can only be determined after an individual assessment by a qualified practitioner who discusses the benefits, limitations and risks with you first.
Prevention of Xanthelasma
Reducing the risk of xanthelasma largely involves managing the underlying causes:
- Healthy diet: a balanced diet low in saturated fats can help support healthy lipid levels.
- Regular exercise: physical activity can help with weight management and lipid profiles.
- Medical management: regular check-ups and management of conditions such as diabetes and liver disease, guided by your doctor, can reduce the risk.
Conclusion
Xanthelasma is a benign condition characterised by yellowish plaques around the eyes, and it is often associated with high cholesterol or other lipid metabolism disorders. While it is not harmful in itself, it can be a cosmetic concern, and it can point to an underlying health issue worth investigating.
If you notice any unusual plaques or changes in your skin, the most important step is to see a doctor — both to confirm the diagnosis and to check for any underlying condition such as high cholesterol. If you then choose to have the plaques treated cosmetically, a qualified practitioner can explain the options, their limitations and their risks, and results vary from person to person.
