Cholesterol deposits around the eyes, also known as xanthelasmas, are yellowish lipid deposits that can appear around the eyes. They are most commonly found in individuals in their forties and fifties but can occur in people between the ages of 15 and 73. These deposits are often associated with high cholesterol levels and can be an indication of underlying inherited disorders.
The exact cause of xanthelasmas is not fully understood, but it involves the accumulation of lipid-laden cells in the skin around the eyes. Factors such as primary and secondary hyperlipidemia and certain medications can contribute to their development. While xanthelasmas are generally harmless, they can serve as a predictor of cardiovascular risks.
Treatment options for xanthelasmas are limited and primarily aimed at cosmetic purposes. Consulting a healthcare professional is recommended for a comprehensive understanding of xanthelasmas and accurate information about their management.
Treatment
Cholesterol deposits around the eyes are benign and usually do not cause any skin complications. However, people often seek treatment for cosmetic reasons. While there is limited evidence in the literature regarding effective treatment for xanthelasma in individuals with normal lipid levels, there are commonly recommended approaches. These include using laser ablation, topical trichloroacetic acid, and surgical excision. Some case reports have also suggested that systemic interleukin-1 blockade and cyclosporine-A therapy can be effective in treating xanthelasma. We have eXanthelasmaslored the most commonly used treatment methods for normolipidemic xanthelasma, assessing their efficacy, limitations, and potential side effects.
Systemic Therapy: Probucol
Oral probucol has been reported as a successful treatment in the literature. It is an antioxidant that may prevent the development of atherosclerosis by limiting the oxidative modification of LDL cholesterol, which is important for foam cell formation. A case study was conducted to demonstrate the effectiveness of probucol in treating diffuse normolipemic plane xanthoma, including Xanthelasmas. The results showed positive outcomes. Additionally, another study reported that 68% of xanthelasma cases showed improvement with probucol therapy.
Alirocumab
Alirocumab is a novel anticholesterol therapy belonging to the monoclonal antibody class. Its primary function is to treat hypercholesterolemia by inhibiting Proprotein convertase subtilisin/kexin type 9 (PCSK9). A case report highlighted the situation of a middle-aged man suffering from severe familial hypercholesterolemia and elevated LDL cholesterol levels.The patient eXanthelasmaserienced rapid resolution of Xanthelasmas after treatment with alirocumab, accompanied by a reduction in LDL cholesterol concentrations.
Topical Therapy: Chemical Peel
Chemical peels using trichloroacetic acid (TCA) are commonly used to treat xanthelasma palpebrarum (Xanthelasmas). Different TCA concentrations, such as 35%, 50%, and 70%, have been tested in studies. TCA is applied in a circular manner, with higher concentrations applied to the edges. TCA 70% was found to be the most effective concentration, requiring fewer treatment sessions. TCA 50% was suitable for macular xanthelasma. However, repeated procedures can lead to pigmentation and scarring.
Liquid nitrogen cryotherapy is a simple and effective treatment option, but it is generally avoided for Xanthelasmas due to the risk of intense swelling. Cryotherapy works by causing tissue ischemia and cell death through vasoconstriction and microthrombi formation. Minor swelling and no recurrences were reported in a case series using very short freeze times.
Intralesional pingyangmycin, an antitumor antibiotic, has been used successfully for Xanthelasmas treatment. Satisfactory results were observed in most patients, with minimal complications reported. One patient eXanthelasmaserienced local recurrence after 12 months.
Overall, chemical peels with TCA, liquid nitrogen cryotherapy, and intralesional pingyangmycin are viable treatment options for xanthelasma palpebrarum, each with its own considerations and potential side effects.
Energy-based devices
Energy-based devices like radio-frequency ablation and laser ablation have shown promise for treating xanthelasma palpebrarum (Xanthelasmas). In one study, low-voltage radio-frequency ablation yielded significant improvements for 9 out of 15 patients. Another study compared radio-frequency ablation with trichloroacetic acid (TCA) and found that the former required fewer sessions for lesion clearance but had a higher risk of post-treatment complications. Laser ablation using CO2 and Er:YAG lasers has also been effective, with CO2 laser showing excellent outcomes and Er:YAG laser offering faster healing. Different laser types have been compared to each other and to TCA, with varying results. Overall, further research is needed to determine the most effective and safe treatment approach for Xanthelasmas based on lesion characteristics, desired outcomes, and potential side effects.
Surgery
Surgery is commonly used to remove xanthelasma, with techniques like blepharoplasty and Le Roux's modification being recommended. However, recurrence rates of up to 40% and 60% have been reported for primary and secondary excisions, respectively. A retrospective review found that simple excision with blepharoplasty was the main surgical approach, with additional procedures for advanced cases. Complications were rare, but scar contracture was observed in some cases. Recurrence at 12 months occurred in 3.1% of patients, regardless of lesion grade. Incomplete excisions have higher recurrence rates, particularly when both upper and lower eyelids are involved. Surgical excision is recommended for lesions penetrating the deep dermis or underlying muscle. Some surgical techniques combine surgery with chemical peeling for better results.
While xanthelasmas is generally seen as harmless, it can lead to notable psychological distress due to the resulting cosmetic deformities. Additionally, around 50% of patients with Xanthelasmas may have an underlying plasma lipid disorder caused by abnormalities in lipoproteins or apolipoproteins. It is important to screen patients for the root causes of hyperlipidemia and provide follow-up care for any related health complications. Although cholesterol deposits around the eyes rarely present functional issues, many seek treatment primarily for aesthetic purposes. Regrettably, recurrence is common regardless of the therapeutic approach, and a definitive long-term treatment solution is yet to be determined.
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