Xanthelasma Palpebrarum: More than Meets the Eye

  • Shailesh Khode
  • Soon Heng Terry Tan
  • En-Pei Amanda Tan
  • Sandeep Uppal
Original Article


Xanthelasma palpebrarum (XP) is the most common form of cutaneous xanthomata, and is important aesthetically, because of its close relation to the eyes, as well as medically for its association with cardiovascular disease (CVD). To provide avant-garde review discussing the various aspects of XP, including its aetio-pathogenesis and various treatment modalities. A structured Pubmed and Medline were searched for relevant articles. The finding of recent research has strongly espoused the link between XP and CVD, and mechanisms have been suggested for its formation. The new technologies have led to a multitude of treatment options for XP. XP is a multi-faceted entity; other than simple treatment of the cosmetic aspect of the disease, one must be cognizant of its cardiovascular implications.


Xanthelasma palpebrarum Lipid Cardiovascular disease Tri-chloroacetic acid Laser Blepharoplasty 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Bergman R (1994) The pathogenesis and clinical significance of xanthelasma palpebrarum. J Am Acad Dermatol 30(2):236–242CrossRefPubMedGoogle Scholar
  2. 2.
    Domonkoa AN, Arnold HL Jr., Odom RB (1982) Andrews’ diseases of the skin: clinical dermatology, 7th edn. WB Saunders, Philadelphia, pp 658–660Google Scholar
  3. 3.
    Jónsson A, Sigfŭsson N (1976) Letter: significance of xanthelasma palpebrarum in the normal population. Lancet 1(7955):372CrossRefPubMedGoogle Scholar
  4. 4.
    Dequeker J, Muls E, Leenders K (2004) Xanthelasma and lipoma in Leonardo da Vinci’s Mona Lisa. Isr Med Assoc J 6(8):505–506PubMedGoogle Scholar
  5. 5.
    Kim J, Kim YJ, Lim H, Lee SI (2012) Bilateral circular xanthelasma palpebrarum. Arch Plast Surg 39(4):435–437CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Sarkany RPE, Breathnach SM, Seymour CA et al (2004) Metabolic and nutritional diseases. In: Burns T, Breathnach S, Cox N et al (eds) Rook’s textbook of dermatology, vol 7. Blackwell, Oxford, p 57.1e57.124Google Scholar
  7. 7.
    Matsumoto M, Kunimitsu S, Wada K, Ikeda M, Keyama A, Kodama H (2007) Mast cell distribution, activation, and phenotype in xanthoma. J Am Acad Dermatol 56(6):1006–1012CrossRefPubMedGoogle Scholar
  8. 8.
    Parker F, Odland GF (1968) Experimental xanthoma. A correlative biochemical, histologic, histochemical, and electron microscopic study. Am J Pathol 53(4):537–565PubMedPubMedCentralGoogle Scholar
  9. 9.
    Parker F, Peterson N, Odland GF (1966) A comparison of cholesterol-ester fatty acid patterns in the blood and in evolving xanthoma and atheroma during cholesterol-feeding of rabbits. J Invest Dermatol 47(3):253–259CrossRefPubMedGoogle Scholar
  10. 10.
    Watanabe A, Yoshimura A, Wakasugi T et al (1981) Serum lipids, lipoprotein lipids and coronary heart disease in patients with xanthelasma palpebrarum. Atherosclerosis 38:283–290CrossRefPubMedGoogle Scholar
  11. 11.
    Ribera M, Pinto X, Argimon JM et al (1995) Lipid metabolism and apolipoprotein-E phenotypes in patients with xanthelasma. Am J Med 99:485–490CrossRefPubMedGoogle Scholar
  12. 12.
    Gómez JA, Gónzalez MJ, de Moragas JM, Serrat J, Gónzalez-Sastre F, Pérez M (1988) Apolipoprotein E phenotypes, lipoprotein composition, and xanthelasmas. Arch Dermatol 124(8):1230–1234CrossRefPubMedGoogle Scholar
  13. 13.
    Montgomery H, Osterberg A (1938) Xanthomatosis: correlation of clinical, histopathologic, and chemical studies of cutaneous xanthoma. Arch Dermatol 37:373–401CrossRefGoogle Scholar
  14. 14.
    Vacca JB, Knight WA, Broun GO (1959) Clinical observations regarding xanthelasma. Ann Intern Med 51:1019–1031CrossRefPubMedGoogle Scholar
  15. 15.
    Epstein NN, Rosenmann RH, Gofman JW (1952) Serum lipoproteins and cholesterol metabolism in xanthelasma. Arch Dermatol 65:70–81CrossRefGoogle Scholar
  16. 16.
    Pedace JF, Winkelmann RK (1965) Xanthelasma palpebrarum. J Am Med Assoc 193:893–894CrossRefGoogle Scholar
  17. 17.
    Bergman R (1998) Xanthelasma palpebrarum and risk of atherosclerosis. Int J Dermatol 37(5):343–345CrossRefPubMedGoogle Scholar
  18. 18.
    Bergman R, Kasif Y, Aviram M, Maor I, Ullman Y, Gdal-On M, Friedman-Birnbaum R (1996) Normolipidemic xanthelasma palpebrarum: lipid composition, cholesterol metabolism in monocyte-derived macrophages, and plasma lipid peroxidation. Acta Derm Venereol 76(2):107–110PubMedGoogle Scholar
  19. 19.
    Douste-Blazy P, Marcel YL, Cohen L, Giroux JM, Davignon J (1982) Increased Frequency of Apo E-ND phenotype and hyperapobeta-lipoproteinemia in normolipidemic subjects with xanthelasmas of the eyelids. Ann Intern Med 96(2):164–169CrossRefPubMedGoogle Scholar
  20. 20.
    Greenland P, Abrams J, Aurigemma GP et al (2000) Prevention conference V: beyond secondary prevention: identifying the high-risk patient for primary prevention: non-invasive tests of atherosclerotic burden—Writing Group III. Circulation 101:E16e22CrossRefGoogle Scholar
  21. 21.
    Noël B (2007) Premature atherosclerosis in patients with xanthelasma. J Eur Acad Dermatol Venereol 21(9):1244–1248PubMedGoogle Scholar
  22. 22.
    Pandhi D, Gupta P, Singal A, Tondon A, Sharma S, Madhu SV (1038) Xanthelasma palpebrarum: a marker of premature atherosclerosis (risk of atherosclerosis in xanthelasma). Postgrad Med J 2012(88):198–204Google Scholar
  23. 23.
    Akyuz AR, Turan T, Erkus ME, Gurbak KS et al (2016) Xanthelasma palpebrarum associated with increased cardio-ankle vascular index in asymptomatic subjects. Wien Klin Wochenschr 128(suppl 8):610–613CrossRefPubMedGoogle Scholar
  24. 24.
    Bhat J, Smith AG (2003) Xanthelasma palpebrarum following allergic contact dermatitis from para-phenylenediamine in a black eyelash-tinting product. Contact Dermat 49(6):311CrossRefGoogle Scholar
  25. 25.
    Platsidaki E, Kouris A, Agiasofitou E, Antoniou C, Kontochristopoulos G (2016) Periorbital hyperpigmentation in patients with xanthelasma palpebrarum :an interesting observation. J Clin Aesthet Dermatol 9(4):52–54PubMedPubMedCentralGoogle Scholar
  26. 26.
    D’Acunto C, Pazzaglia M, Raone B, Misciali C, Badiali L, Neri I, Patrizi A (2013) Xanthelasma palpebrarum: a new adverse reaction to intradermal fillers? Br J Dermatol 168(2):437–439CrossRefPubMedGoogle Scholar
  27. 27.
    Başterzi Y, Sari A (2006) Xanthelasma palpebrarum after septorhinoplasty. Aesthetic Plast Surg 30(4):492–493CrossRefPubMedGoogle Scholar
  28. 28.
    Scott PJ, Winterbourn CC (1967) Low-density lipoprotein accumulation in actively growing xanthomas. J Atheroscler Res 7(2):207–223CrossRefPubMedGoogle Scholar
  29. 29.
    Seike M, Ikeda M, Matsumoto M, Hamada R, Takeya M, Kodama H (2006) Hyaluronan forms complexes with low density lipoprotein while also inducing foam cell infiltration in the dermis. J Dermatol Sci 41(3):197–204CrossRefPubMedGoogle Scholar
  30. 30.
    Sayin L, Ayli M, Oguz AK, Sevel GC (2016) Xanthelasma palpebrarum: a new side effect of nilotinib. BMJ Case Rep. PubMedPubMedCentralGoogle Scholar
  31. 31.
    Karsai S, Czarnecka A, Raulin C (2010) Treatment of xanthelasma palpebrarum using a pulsed dye laser: a prospective clinical trial in 38 cases. Dermatol Surg 36(5):610–617CrossRefPubMedGoogle Scholar
  32. 32.
    Parkes ML, Waller TS (1984) Xanthelasma palpebrarum. Laryngoscope 94(9):1238–1240CrossRefPubMedGoogle Scholar
  33. 33.
    Lee HY, Jin US, Minn KW, Park Y-O (2013) Outcomes of surgical management of xanthelasma palpebrarum. Arch Plast Surg 40:380–386CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Kose R (2013) Treatment of large xanthelasma palpebrarums with full-thickness skin grafts obtained by blepharoplasty. J Cutan Med Surg 17(3):197–200CrossRefPubMedGoogle Scholar
  35. 35.
    Roberts HL (1926) The Chloroacetic acids: a biochemical study. Br J Dermatol 38:323–391CrossRefGoogle Scholar
  36. 36.
    Haygood LJ, Bennett JD, Brodell RT (1998) Treatment of xanthelasma palpebrarum with bichloracetic acid. Dermatol Surg 24(9):1027–1031CrossRefPubMedGoogle Scholar
  37. 37.
    Cannon PS, Ajit R, Leatherbarrow B (2010) Efficacy of trichloroacetic acid (95%) in the management of xanthelasma palpebrarum. Clin Exp Dermatol 35(8):845–848CrossRefPubMedGoogle Scholar
  38. 38.
    Haque MU, Ramesh V (2006) Evaluation of three different strengths of trichloroacetic acid in xanthelasma palpebrarum. J Dermatol Treat 17(1):48–50CrossRefGoogle Scholar
  39. 39.
    Nahas TR, Marques JC, Nicoletti A, Cunha M, Nishiwaki-Dantas MC, Filho JV (2009) Treatment of eyelid xanthelasma with 70% trichloroacetic acid. Ophthalmic Plast Reconstr Surg 25(4):280–283CrossRefGoogle Scholar
  40. 40.
    Dincer D, Koc E, Erbil AH, Kose O (2010) Effectiveness of low-voltage radiofrequency in the treatment of xanthelasma palpebrarum: a pilot study of 15 cases. Dermatol Surg 36(12):1973–1978CrossRefPubMedGoogle Scholar
  41. 41.
    Dawber R, Colver G, Jackson A, Pringle F (1992) Cutaneous cryosurgery. Principles and Clinical practice. Martin Dunitz, LondonGoogle Scholar
  42. 42.
    Kuflik EG, Gage AA (1990) Cryosurgical treatment of skin cancer. Igaku-Shoin, NewyorkGoogle Scholar
  43. 43.
    Sheperd J, Dawber RP (1982) The historical and scientific basis of cryosurgery. Clin Exp Dermatol 7:321–328CrossRefGoogle Scholar
  44. 44.
    Dewan SP, Kaur A, Gupta RK (1995) Effectiveness of cryosurgery in xanthelasma palpebrarum. Indian J Dermatol Venereol Leprol 61(1):4–7PubMedGoogle Scholar
  45. 45.
    Labandeira J, Vázquez-Osorio I, Figueroa-Silva O, Pereiro M Jr, Toribio J (2015) Tolerability and effectiveness of liquid nitrogen spray cryotherapy with very short freeze times in the treatment of xanthelasma palpebrarum. Dermatol Ther 28(6):346–350CrossRefPubMedGoogle Scholar
  46. 46.
    Delgado Navarro C, Lanuza García A, Llorca Cardeñosa A, Bañón-Navarro R, Corchero MG (2013) Application of laser CO2 for the treatment of xanthelasma palpebrarum. Arch Soc Esp Oftalmol 88:320–322CrossRefPubMedGoogle Scholar
  47. 47.
    Raulin C, Schoenermark MP, Werner S, Greve B (1999) Xanthelasma palpebrarum: treatment with the ultrapulsed CO2 laser. Lasers Surg Med 24(2):122–127CrossRefPubMedGoogle Scholar
  48. 48.
    Pathania V, Chatterjee M (2015) Ultrapulse carbon dioxide laser ablation of xanthelasma palpebrarum: a case series. J Cutan Aesthet Surg 8(1):46–49CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Saif MYS (2007) Xanthelasma palpebrarum treatment by CO2 laser. Bull Ophthalmol Soc Egypt 100:791–794Google Scholar
  50. 50.
    Esmat SM, Elramly AZ, Abdel Halim DM, Gawdat HI, Taha HI (2014) Fractional CO2 laser is an effective therapeutic modality of xanthelasma palpebrarum: a randomized clinical trial. Dermatol Surg 40(20):1349–1355CrossRefPubMedGoogle Scholar
  51. 51.
    Borelli C, Kaudewitz P (2001) Xanthelasma palpebrarum: treatment with the erbium:YAG laser. Lasers Surg Med 29(3):260–264CrossRefPubMedGoogle Scholar
  52. 52.
    Mannino G, Papale A, De Bella F, Mollo R (2001) Use of Erbium:YAG laser in the treatment of palpepral xanthelasmas. Opthalmic Surg Lasers 32:129–133Google Scholar
  53. 53.
    Kaufmann R, Hibst R (1996) Pulsed Erbium-YAG laser ablation in cutaneous surgery. Lasers Surg Med 19:324–330CrossRefPubMedGoogle Scholar
  54. 54.
    Drnovsek-Olup B, Vedlin B (1997) Use of Erbium:YAG laser for benign skin disorders. Lasers Surg Ned 21:13–19CrossRefGoogle Scholar
  55. 55.
    Levy JL, Trelles MA (2003) New operative technique for treatment of xanthelasma palpebrarum: laser-inverted resurfacing: preliminary report. Ann Plast Surg 50(4):339–343CrossRefPubMedGoogle Scholar
  56. 56.
    Anderson RR, Margolis RJ, Watenabe S, Flotte T, Hruza GJ, Dover JS (1989) Selective photothermolysis of cutaneous pigmentation by Q-switched Nd: YAG laser pulses at 1064, 532, and 355 nm. J Invest Dermatol 93(1):28–32CrossRefPubMedGoogle Scholar
  57. 57.
    Fusade T (2008) Treatment of xanthelasma palpebrarum by 1064-nm Q-switched Nd: YAG laser: a study of 11 cases. Br J Dermatol 158(1):84–87PubMedGoogle Scholar
  58. 58.
    Karsai S, Schmitt L, Raulin C (2009) Is Q-switched neodymium-doped yttrium aluminium garnet laser an effective approach to treat xanthelasma palpebrarum? Results from a clinical study of 76 cases. Dermatol Surg 35(12):1962–1969CrossRefPubMedGoogle Scholar
  59. 59.
    Marini L (2013) 1064 nm Q-switched photo-acoustic laser ablation of xanthelasma palpebrarum. J Laser Health Acad 1:48–51Google Scholar
  60. 60.
    Berger C, Kopera D (2005) KTP laser coagulation for xanthelasma palpebrarum. J Dtsch Dermatol 3(10):775–779CrossRefGoogle Scholar
  61. 61.
    Greijmans E, Luiting-Welkenhuyzen H, Luijks H, Bovenschen HJ (2016) Continuous wave potassium titanyl phosphate laser treatment is safe and effective for xanthelasma palpebrarum. Dermatol Surg 42(7):860–866CrossRefPubMedGoogle Scholar
  62. 62.
    Schönermark MP, Raulin C (1996) Treatment of xanthelasma palpebrarum with the pulsed dye laser. Lasers Surg Med 19(3):336–339CrossRefPubMedGoogle Scholar
  63. 63.
    Astner S (2009) Clinical applicability of a 1 450 nm diode laser as adjunctive treatment for refractory acne. G Ital Dermatol Venereol 144(6):629–638PubMedGoogle Scholar
  64. 64.
    Friedman PM, Jih MH, Kimyai-Asadi A, Goldberg LH (2004) Treatment of inflammatory facial acne vulgaris with the 1450-nm diode laser: a pilot study. Dermatol Surg 30(2 Pt 1):147–151PubMedGoogle Scholar
  65. 65.
    No D, McClaren M, Chotzen V, Kilmer SL (2004) Sebaceous hyperplasia treated with a 1450-nm diode laser. Dermatol Surg 30(3):382–384PubMedGoogle Scholar
  66. 66.
    Chua SH, Ang P, Khoo LS, Goh CL (2004) Nonablative 1450-nm diode laser in the treatment of facial atrophic acne scars in type IV to V Asian skin: a prospective clinical study. Dermatol Surg 30(10):1287–1291PubMedGoogle Scholar
  67. 67.
    Park EJ, Youn SH, Cho EB, Lee GS, Hann SK, Kim KH, Kim KJ (2011) Xanthelasma palpebrarum treatment with a 1450-nm-diode laser. Dermatol Surg 37(6):791–796PubMedGoogle Scholar
  68. 68.
    Shields CL, Mashayekhi A, Shields JA (2005) Disappearance of eyelid xanthelasma following oral simvastatin (Zocor). Br J Ophthalmol 89:639–645CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Wang H, Shi Y, Guan H, Liu C, Zhang W et al (2016) Treatment of xanthelasma palpebrarum with intralesional pingyangmycin. Dermatol Surg 42(3):368–376CrossRefPubMedGoogle Scholar
  70. 70.
    Mourad B, Elgarhy LH, Ellakkawy HA, Elmahdy N (2015) Assessment of efficacy and tolerability of different concentrations of trichloroacetic acid vs. carbon dioxide laser in treatment of xanthelasma palpebrarum. J CosmetDermatol 14(3):209–215Google Scholar
  71. 71.
    Goel K, Sardana K, Garg VK (2015) A prospective study comparing ultrapulse CO2 laser and trichloroacetic acid in treatment of Xanthelasmapalpebrarum. J Cosmet Dermatol 14(2):130–139CrossRefPubMedGoogle Scholar
  72. 72.
    Abdelkader M, Alashry SE (2015) Argon laser versus erbium:YAG laser in the treatment of xanthelasma palpebrarum. Saudi J Ophthalmol 29(2):116–120CrossRefPubMedGoogle Scholar
  73. 73.
    Güngör S, Canat D, Gökdemir G (2014) Erbium:YAG laser ablation versus 70% trichloroacetıc acid application in the treatment of xanthelasma palpebrarum. J Dermatol Treat 25(4):290–293CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2018

Authors and Affiliations

  1. 1.Department of Otolaryngology – Head and Neck SurgeryKhoo Teck Puat HospitalYishunSingapore

Personalised recommendations