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How do I treat case of xanthelasmata?

QA patient with marked xanthelasmata is considering having them removed surgically; those on her lower eyelid will have to remain as she is at risk of ectropion. Is there any evidence that lowering her cholesterol could cause these to regress?

A Xanthelasmata usually appear as bilateral asymptomatic soft yellowish velvety plaques on the upper eyelid and around the inner canthus. They are one of the commonest forms of xanthoma and represent an accumulation of lipid-containing macrophages in the dermis. Lipid levels are normal in some 50 per cent of affected individuals, although in young affected persons there is a higher incidence of hypercholesterolaemia.

Reassuringly, a study of more than 8,000 subjects in Iceland showed no association between xanthelasmata and heart disease.

Treatment options include electrodessication followed by curettage, cautious application of trichloracetic acid using a cotton wool bud, or excision ­ but this is rarely performed.

Lipid levels should be checked in a patient presenting with xanthelasmata, and dietary modification with or without drug treatment introduced accordingly. It is important to take a thorough family history since familial forms of hyperlipidaemia may be present in this way.

There is no evidence that cholesterol reduction has any impact on the appearance of xanthelasmata. Many lesions recur even after effective local treatment, and it is not know if lipid levels have any impact on the rate at which they develop.

Dr Catherine Orteu is a consultant dermatologist at the

Royal Free Hospital, London

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