Xanthelasma Removal

Xanthelasma are yellow cholesterol deposits found around the inner eyelids. While not uncommon in the general population, they are seen more often in individuals with high blood cholesterol levels. They are harmless skin growths and do not by itself cause any health problems. Xanthelasma removal with laser surgery is associated with faster healing rates and without the need for stitches.

xanthelasma-removal
Image from DermnetNZ.org

About Xanthelasma

Xanthelasma (aka Xanthelasma Palpebrarum) are yellow coloured cholesterol deposits that are found on the eyelids. It may affect the inner aspect of the upper and lower eyelids at the same time. They grow slowly over time, and do not cause symptoms such as itch or pain. They feel soft, and can either remain stable or grow larger over time. Most individuals request xanthelasma removal because of the undesirable cosmetic appearance.

 

xanthelasma removal

How Common Are Xanthelasmas?

Xanthelasmas can occur at any age, but are more common with older age. With an estimated prevalence of about 4% in the general population, it tends to affect women more commonly than men. The peak ages of appearance of xanthelasma is from the 4th and 5th decades, although there are reports of it occurring in individuals as young as 15 years of age.

high cholesterol is associated with xanthelasma

Why Do I Get Xanthlasmas?

While most individuals with xanthelasma have high cholesterol levels, xanthelasma can also occur in people with normal cholesterol levels. High cholesterol levels may be due to an inherited condition (e.g. familial hypercholesterolaemia) or may be due to secondary causes such as diabetes, obesity, hypothyroidism.

Dieting and taking medications to control high cholesterol does not readily improve the xanthelasma. Having xanthelasma may be a predictive risk factor for heart attacks and coronary artery diseases. Therefore, it is important to go for a health check if you detect the presence of xanthelasma.

Xanthelasma Treatment Options:

Even though xanthelasmas are asymptomatic and not harmful, individuals often seek treatment as they find the appearance of xanthelasmas to be cosmetically unappealing.

The treatment considerations takes into account the size of the xanthelasma, thickness, skin phototype, previous treatments and any underlying medical condition. Treatment Options include;

1.Topical therapy:

  • Chemical peels
  • Liquid nitrogen cryotherapy

2. Energy based devices:

  • Radio-frequency ablation
  • CO2 laser surgery
  • Er:YAG laser surgery
  • Argon laser
3. Surgery
 
Chemical peels such as Trichloroacetic acid may be suitable for smaller xanthelasmas. However, they run the risk of post-inflammatory hyperpigmentation, scarring and lid eversion (ectropion). Liquid nitrogen therapy on the other hand, is painful and causes swelling and blisters, and are generally avoided in areas such as the eyelids where the skin is thinner. Surgery has a role where xanthelasmas are extensive and extend deeply into the underlying tissue layers.
laser xanthelasma remova;

Laser Xanthelasma Removal Surgery

Xanthelasma removal with CO2 (Carbon Dioxide) Laser surgery is a precise way to destroy the cholesterol deposits.

CO2 lasers work by vaporising the water found in cells. When compared to chemical peels, CO2 laser surgery is associated with better clearance. In addition, laser surgery is associated with less bleeding, faster recovery and without the need for stitches removal.

Following surgery, there is a chance of xanthelasma returning. Studies have shown that xanthelasma may recur in up to a quarter of cases in the first year. This is because some xanthelasma deposits may extend deeper into the skin layers. The rate of recurrence is associated with a high cholesterol levels and multiple eyelids being affected. Repeated treatments may be needed in some cases.

Most individuals recover usually within 7-10 days. A scab typically forms over the wound over 2-3 days and falls off in a week.

As with any surgical procedures, there is a risk of bleeding, infection and scarring. All these can be prevented and mitigated with good skin care. A topical antibiotic is to be applied for a week after the procedure.

Most individuals heal well with minimal scarring. The initial healing will result in the wound site being pinkish but will almost blend in with the surrounding skin as healing occurs.

Ensure that the wound is kept clean and avoid activities that increases the risk of wound contamination. Direct sun exposure is to be avoided for at least 4 weeks to reduce the occurrence of post-inflammatory hyperpigmentation.

This depends on a host of factors e.g. genetic susceptibility, depth of xanthelasma, number of xanthelasmas and serum cholesterol levels. While most individuals get good results after a single procedure, it is not uncommon for xanthelasma to recur regardless of the treatment modality. Laser xanthelasma removal is a treatment to improve the cosmetic appearance and is by no means curative of xanthelasma.

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Reference:
  1. Christoffersen M, Frikke-Schmidt R, Schnohr P, et al. Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study. BMJ. 2011 Sep 15. 343:d5497.
  2. Basar E, Oguz H, Ozdemir H, et al. Treatment of xanthelasma palpebrarum with argon laser photocoagulation. Argon laser and xanthelasma palpebrarum. Int Ophthalmol. 2004 Jan. 25(1):9-11.
  3. Usatine RP. A cutaneous manifestation of a systemic disease. West J Med. 2000 Feb. 172(2):84.
  4. Goel K, Sardana K, Garg VK. A prospective study comparing ultrapulse CO2 laser and trichloroacetic acid in treatment of xanthelasma palpebrarum. J Cosmet Dermatol. 2015;14:130–9.
  5. Laftah, Z., & Al-Niaimi, F. (2018). Xanthelasma: An Update on Treatment Modalities. Journal of cutaneous and aesthetic surgery11(1), 1–6. https://doi.org/10.4103/JCAS.JCAS_56_17