What is Xanthelasma?
Xanthelasma (otherwise called by specialists xanthelasma palpebrarum) is a particular type of Xanthoma, a yellowish deposit of fat underneath the skin, usually on the eyelids and/or around them. Therefore Xanthelasma can be referred to as a Xanthoma, but not viceversa. The process in the formation of Xanthelasmas and Xanthomas are the same but we refer to Xanthelasmas only once the Xanthomas develop around the eyes or on the eyelids. Xanthelasmas are composed of xanthoma cells which are foamy formations with intracellular fat deposits primarily located within the upper reticular dermis and epidermis. Put more simply, Xanthelasmas are collections of certain types of fat, mostly cholesterol and triglycerides derived from food.
These lesions appear in those individuals whose body is unable to efficiently break down fats into usable energy. Sometimes diabetes, hypothyroidism, liver problems, and most prominently genetics can all contribute to the growth of Xanthelasmas. Recently the role of acetylated LDL and macrophages with their scavenger receptors has been observed in the causation of Xanthelasma Palpebrarum. Since Xanthelasmas are fat formations, they have little nervous terminations therefore they are not painful. The incidence of xanthelasma in the general population has been reported between 0.3% and 1.5%. The age of onset ranges from 15 to 73 years with a peak incidence in the 4th and 5th decades.
Throughout our experience in treating this condition, Xanthelasmas appear to be lesions predominantly observed on females. Although this higher reported incidence has been corroborated by other independent studies this maybe due to the fact that women are more self-conscious of cosmetic conditions than men.
Xanthelasmas have few nervous terminations, however during removal using lasers or similar equipment the patient may feel pain due to the transferred heat to the surrounding healthy skin around the eyes. Xanthelasmas are not harmful to keep either, these minor growths are unsightly and can be easily removed.
At Akronics, due to the type of customers we have served, can now say Xanthelasmas are equally common in Asians, Caucasians and people coming from any ethnic origin. Many still believe that the formation of Xanthelasmas are directly related to the Cholesterol levels of the individual developing the condition. However a direct correlation between high lipids levels and the formation of Xanthelasmas has not been proven. It has been found that many of those developing Xanthelasmas have normal Cholesterol blood levels.
It seems instead that certain individuals are more likely than other to develop Xanthelasmas mainly to hereditary factors. This is confirmed by studies conducted on a large number of people who developed the condition. It has been found that the the high cholesterol incidence level of the Xanthelasma sufferers is the close to those of the normal population not developing Xanthelasmas. Therefore unless proven otherwise it can high cholesterol levels and the development of Xanthelasmas may not be directly related.
On the contrary, there seems to be a hereditary component which contributes to the development of the condition, hence should a close relative is affected or was affected by the condition you will be more likely to develop Xanthelasmas despite you Cholesterol levels. Only when there is no family history of Xanthelasma, the condition could be related to high cholesterol levels.
The Xanthelasma condition is usually assessed by family doctors and dermatologists, however given that there is little research done on Xanthelasma, the advise offered may not be the in the best interests of the patient. In fact some practitioners have advised their patients that it is too risky to have their Xanthelasmas treated because they could end up being scarred in the process. This advice had been offered because the there is no inherent health risks in keeping the Xanthelasmas (benign growths) and little information is available on how to have Xanthelasmas properly removed. However is has been proven that when removed with the latest treatments the risks of scarring are remote.
For a long time Xanthelasmas have been referred to as an indicator of potential high risks of cardio-vascular disease (stokes and heart attacks). However, to this day, no scientific study has been carried out to corroborate the link between Xanthalasma formation and cardio-vascular diseases. Nevertheless, many still say that those affected by Xanthelesmas are more likely to die younger due to heart attacks or strokes.
Initially, this alleged higher mortality of those affected by Xanthelasmas was believed to be due to the high cholesterol levels of those affected by Xanthelasmas. After all, the common belief was that high cholesterol levels caused the Xanthelasmas formation in the first place. However, no evidence of this has been found, especially given that the cholesterol levels of many affected are normal. A study was carried out showing an association between Xanthelasma formation and cardiovascular disease. In this study it is shown how similar the Xanthelasmas and Xanthomas development process is to the formation of plaques within the arteries (atheromatous disease). Lately a study has associated the formation of Xanthelasmas with a 17% greater risk of mortality due to cardio-vascular diseases when compared with those without Xanthelasmas.
Xanthelasmas appear on both eyes symmetrically in the vast majority of the cases. It has not been reported a case of Xanthelasmas on one eye only without the other eye being affected. However it has been reported of people who developed Xanthomas without ever developing Xanthelasmas and vice versa.
Although Xanthelasmas are skin lesions, fortunately they are relatively usually superficial and they do not grow too deeply into the dermis. The fat that makes up Xanthelasmas resides between the superficial part of the dermis and the epidermis, in the same fashion as common warts. Therefore the successful treatment and removal without leaving no scarring is feasible.
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