By Gary M. White, MD
Xanthelasma are caused by the accumulation of lipid-laden macrophages in the skin. Yellow papules and plaques, usually about the eyes, result.
Soft, yellow papules and/or plaques on the upper inner eyelids are characteristic of xanthelasma. They may occur as an isolated finding or be associated with hyperlipidemia. All patients should have a lipid profile.
Several patients with granulomatosis with polyangiitis have had florid xanthelasmata [Br J Ophth 1995;79;453].
The most important intervention is to control the cholesterol so as to reduce the risk of coronary artery disease. One patient's xanthelasma completely disappeared after 10 years of oral statin therapy combined with dietary cholesterol restriction [Br J Ophthalmol. 2005 May; 89(5): 639–640].
No treatment is needed for xanthelasma. Surgical removal may be performed. After local anesthesia, the lesions may be grabbed with forceps and snipped off with scissors. Healing may occur by secondary intention or primary closure may be performed. Alternatively, trichloroacetic acid may be used. Finally, light electrocautery has been advocated. After bleb formation with lidocaine (may be spread across the lower lateral canthus with a cotton-tipped applicator), light electrocautery, e.g., 3-5 setting may be employed [J Drugs Dermatol 2016;15;891].
Gentle liquid nitrogen spray cryotherapy has been proposed as an effective treatment [Dermatol Ther. 2015 Jun 18]. Various lasers have been used (e.g., Ultrapulse carbon dioxide laser [J Cutan Aesthet Surg 2015;8:46], Argon, erbium:YAG], 1064-nm Q-switched Nd:YAG [JAAD 2017;77;728], but pigmentary change is one potential side effect.