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Xanthelasma is a very common benign skin condition that affects the upper or lower eyelid. What are the symptoms ? The causes ? Treatments ? Insights from Dr Nathalie Deschamps Lefèvre, ophthalmic surgeon at OPH 78.
Definition: what is xanthelasma or eyelid xanthoma?
A deposit of cholesterol in the eyelid
Xanthelasma, or eyelid xanthoma, is a common skin condition which is characterized by a small whitish or yellowish lesion located under the skin, at the level of the upper or lower eyelids or even both. This lesion results from the accumulation of lipid deposits (cholesterol and triglycerides) under the skin. In principle, this fatty deposit is completely benign and requires no treatment, unless it is responsible for aesthetic and/or functional discomfort.
What causes xanthelasma?
“In approximately half of the cases, xanthelasma is idiopathic. In the other half of the cases, these lesions can be linked to hypercholesterolemia, most often of familial (hereditary) origin”indicates Dr Nathalie Deschamps Lefèvre.
What are the symptoms of xanthelasma?
Xanthelasma manifests itself by the appearance of whitish or yellowish plaques on the upper or lower eyelid or even both. “These lesions are quite thin, flat, and painless. The discomfort felt by the patient is essentially aesthetic”specifies the ophthalmic surgeon.
Who to consult to remove xanthelasma and how is the diagnosis made?
The diagnosis is clinical. It is generally carried out by the attending physician who refers his patient to a dermatologist or ophthalmologist. “It is best to consult an ophthalmologist or dermatologist but most often, lesions on the eyelids are removed by the ophthalmologist,” explains the specialist. A biopsy is not necessary.
Treatment: how to get rid of xanthelasma?
Xanthelasma does not present no severity criteria and is not at risk of developing into cancer. Therefore, in the absence of cosmetic discomfort, it is not obligatory to treat xanthelasma. On the other hand, if the lesions are large or unsightly, or if they cause functional discomfort, treatment may be offered.
There are two types of treatments to remove xanthelasma plaques: laser and surgery.
- Surgical treatment, which is based on the removal of the lesion by the ophthalmic surgeon in the operating room. This excision is carried out under local anesthesia. The scar is hardly noticeable;
- Laser treatment: thanks to the emission of heat, fat deposits are pulverized. “Many lasers have been tested in recent years and it seems that the most suitable is the excisional plasma laser,” comments Dr Nathalie Deschamps Lefevre. This technique is carried out under local anesthesia. The after-effects of the operation are very simple and only last a few days. Edema and crusting may eventually occur. The only downside is that the risks of recurrence are high.
Prevention: how to avoid xanthelasma?
“Unfortunately, it is impossible to prevent the occurrence of xanthelasma. Patients with familial hypercholesterolemia are treated but this does not mean that xanthelasma will disappear”deplores the ophthalmic surgeon.
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