Photoclinic: Xanthelasma Palpebrarum

These yellow asymptomatic lesions on the inner upper eyelids of a 36-year-old woman had persisted for 2 years. She had a history of type 2 diabetes mellitus, migraine, nicotine dependence, bipolar disorder, and obesity. Her medications included quinapril, insulin aspart injection, sumatriptan, ziprasidone, and temazepam. The patient’s total cholesterol level was 198 mg/dL; low-density lipoprotein cholesterol, 125 mg/dL; highdensity lipoprotein cholesterol (HDL-C), 28 mg/dL; and triglycerides, 134 mg/dL. The hemoglobin A1c  level was 6.3%. Laurie Meng, PA-C, and Jack-Ky Wang, MD, of Palos Heights, Ill, diagnosed xanthelasma palpebrarum. These benign, painless lesions contain fat and cholesterol. Often, they develop on the medial canthus of the eyelids—typically the upper eyelids—and are symmetric. However, all 4 eyelids can be involved, as well as other areas, such as the elbows, knees, and other joints; hands; feet; buttocks; and the skin overlying tendons. About half of patients with xanthelasma palpebrarum have elevated lipid levels. Low HDL-C levels, uncontrolled diabetes and, rarely, biliary cirrhosis are other possible causes. In case studies of patients with xanthomatosis, xanthelasma was more common among women (32%) than among men (17.4%). Although treatment of the underlying disorders is important, reduced lipid levels and tighter glycemic control have only a modest effect on xanthelasma palpebrarum. Removal of the lesions by surgical excision, argon or carbon dioxide laser ablation, chemical cauterization, electrodesiccation, or cryotherapy is an option for cosmesis. Simvastatin was prescribed and dietary changes and smoking cessation were recommended for this patient. After reassurance, she chose not to have the lesions removed.