What are xanthelasmata?
Xanthelasma palpebrarum is a condition in which benign fat deposits develop in the skin, especially around the eyes. They are part of a larger “family” of skin lesions called xanthomata, which can point to disturbances of the body’s fat metabolism. In the majority of cases, however, people with xanthelasmata around the eyes have no abnormalities of the fat and cholesterol levels in the blood.
What do they look like?
Xanthelasmata are yellowish, flat plaques lying very superficially in the skin of the eyelids. They typically begin as small individual spots but can eventually merge into patches several centimetres in size.
How is xanthelasma treated?
Although most people with xanthelasmata have no abnormalities in the body’s fat balance, the doctor will have blood tests done to check this. The spots themselves can be treated successfully, with several options:
- Trichloroacetic acid (TCA) solution — this strongly caustic fluid is carefully applied to the skin by the doctor with a wooden stick. After a few seconds the treated skin turns white, and eventually a crust forms that then falls off. Usually several treatments are needed. An advantage is that no anaesthetic is required. Over time the spots usually return.
- Electrocoagulation — the fat deposits can be melted away with a small electric current through a fine metal needle or ball, after local anaesthetic. It must be done very precisely by an experienced doctor to minimise scarring (which cannot always be prevented).
- Laser therapy — the CO2 laser can also remove the deposits, vaporising the fat-containing cells layer by layer, with a cosmetic result broadly comparable to coagulation.
- Surgery — some larger xanthelasmata can be removed surgically, depending on their location. The result is often good, but the deposits can return near the scar.
What is the outlook?
The results of treatment are unfortunately quite variable, and in many cases the deposits return over time, either at treated sites or at new sites on the eyelids.
When to see a doctor
See a doctor if yellowish spots develop on the eyelids — the fat levels in your blood can be checked and treatment options discussed.