Xanthelasma

What happens if there is removal of too much of the anterior lamella of the eye lids?

Cicatricial ectropion

What is the differential diagnosis of Xanthelasma?

Erdheim-Chester disease, a systemic xanthogranulomatous disorder, which has lesions that typically appear more indurated.

What is the histological appearance of Xanthelasma?

Foam cells in the superficial dermis. The cells cluster around blood vessels and may even involve their walls. Surrounding fibrosis and inflammation may be observed.

What is a foam cell?

Lipid laden macrophages containing Low density lipoproteins

What happens if extension is deep into the orbicularis muscle?

May not be amenable to surface ablative therapies

What is the stain for Xanthelasma?

Oil red O

Is xanthelasma a form of xanthoma or lipogranuloma?

Xanthoma

What is the difference between a xanthoma and a lipogranuloma?

Xanthoma [i.e., a tumor containing fat mainly within cells (intracellular)], whereas a lipogranuloma (e.g., a chalazion) is a tumor containing fat mainly outside cells (extracellular).

What is the epidemiology?

middle-aged and older adults

What is the clinical appearance of Xanthelasma palpebrarum?

soft, yellow plaques on the medial aspect of the eyelids (upper and lower)

What are the associations that can occur with xanthelasma?

· primary hypercholesterolemia · with nonfamilial serum cholesterol elevation · other types of xanthomas · hyperlipoproteinemic states II and III

Describe the likelihood of recurrence of Xanthelasma.

• Recurrence is common. • After initial surgical excision, the recurrence rate is slightly less than half. • Recurrence is more likely if all four lids are involved, if an underlying hyperlipemia syndrome is present, or if there have been previous recurrences.

What is the treatment for Xanthelasma?

• Surgical excision --removing too much of the anterior lamella of the eyelids can lead to cicatricial ectropion. • carbon dioxide laser ablation • topical trichloroacetic acid.