Xanthoma (Xanthelasma)

Xanthoma is a type of skin lesion caused by the excessive presence of fat in the macrophage immune cells. Some types of xanthoma are direct indicators of disorders associated with lipid metabolism, such as high blood fat and hyperlipidemia.

Types of xanthomas are classified according to their location on the body and how they develop.

Xanthelasma palpebrum is the most common type of xanthoma. The lesions form symmetrically on the upper and lower eyelids. They are described as soft, yellow, and flat papules or plaques in appearance. Lesions initially appear as small bumps but eventually increase in size after a few months.

Xanthoma is caused predominantly by the disturbance in lipid (fat) metabolism. Alterations in the levels of certain lipids and lipoproteins may cause genetic defects (hyperlipoproteinaemia) or systemic disorders such as diabetes mellitus and nephrotic syndrome.

Skin biopsy is sometimes performed in order to confirm the diagnosis of xanthoma. Treatment of xanthoma is closely linked with identifying and treating the underlying lipid disorder. This approach helps to reduce or clear the xanthoma. A combination of dietary and lifestyle modifications, with or without medication, is used for the treatment of lipid disorders. Dietary modifications include reducing intake of saturated fats (coconut oil, palm oil, butter, some meats) and simple, refined sugars (cakes, candies, soda drinks). A diet rich in vegetables, cereals, and fish is recommended.

Xanthoma is also often treated with prescribed medications that reduce levels of LDL cholesterol and triglycerides, as well as decrease the production of cholesterol by the liver. Treatment is carefully monitored through frequent blood tests in order to assess lipid composition in the body and to ensure that liver and muscle enzymes function normally and do not exhibit any abnormalities. Common medications include statins (simvastatin and atorvastatin), which belong to the class of HMG CoA reductase inhibitors, as well as fibrates (bezafibrate), nicotinic acid, and ezetimibe.

Locally destructive modalities and surgical procedures may also be used to treat xanthoma when the condition cannot be resolved through other means or when the assigned treatment does not show improvement.

Xanthelasma may be treated by excision, laser treatment, electrodesiccation, and topical trichloroacetic acid therapy.