Xanthelasma Palpebrarum are the yellow plaques that can appear on your eyelids. Xanthelasma Palpebrarum most commonly start in the corners of your eyelids and grow out from there.
When they first show up, they will appear small and unobtrusive but over time Xanthelasma Palpebrarum will commonly expand, making their presence know when you look in the mirror. Sometimes Xanthelasma settles down and you will have years of looking at that one little annoying yellow lump, but to be honest most of the time, they will make you think they have calmed down and then burst into life and start growing with vigour.
They are known as eyelid plaques or Xanthelasma, but to put a medical edge on them, they like to go by the name of Xanthelasma Palpebrarum. Follow the link for more information on what causes Xanthelasma.
What is Xanthelasma Palpebrarum?
So let’s get a more in-depth description of what that annoying Xanthelasma Palpebrarum skin condition is. That Xanthelasma your sporting is actually quite a common skin disorder. It is commonly seen in people with high cholesterol or other fat (lipid) levels in the blood, and the plaques contain deposits that are high in fat (lipid-rich).
With today’s food choices, patients affected by it are becoming more and more frequent. It can occur in people of any race and of either sex. However, studies have shown that females seem to be more frequently affected than males. The most common development stage for the condition is in middle age.
Xanthelasma Palpebrarum and Xanthoma
It is the most prevalent of the xanthomas family, with asymptomatic, symmetrical, bilateral, soft, yellow, velvety, polygonal papules around the eyelids. They range in size from 2 – 30mm and are flat surfaced and have distinct borders / edges.
For the client with the Xanthelasma Palpebrarum, they are thankfully not itchy or painful, but once present, Xanthelasma Palpebrarum don’t usually go away on their own. In fact, the plaques frequently grow larger and more numerous. They are ‘foamy’ in nature and classed as a cutaneous necro-biotic disorder.
Xanthelasma Palpebrarum and Lipids
With every patient with Xanthelasma Palpebrarum, they all have underlying lipid abnormalities. Xanthelasma Palpebrarum may occur without any underlying medical condition though. It is not necessarily associated with elevated cholesterol or lipids.
Getting good control of your blood lipids, including triglycerides and cholesterol levels, may help reduce development of xanthomas over all. Having your blood lipids tested is a great way to better understanding what is going on with your lipids andwhy a disorder may be occurring.
Xanthelasma Palpebrarum clinical overview
Xanthelasma Palpebrarum is often accompanied by an elevated erythrocyte sedimentation rate; leukopenia; and monoclonal gammapathy (IgG-kappa type). It is an autosomal recessive lipid storage disorder, due to mutation of the gene CYP27A1 encoding a Cholestanetriol 26-Monooxygenase. It is characterized by large deposits of cholesterol and cholestenol in various tissues, resulting in xanthomatous.
If we were to get some Xanthelasma Palpebrarum under a microscope, we would find that it contains mono- and multinucleated foamy xanthoma cells beset with myriad cytoplasmic vacuoles. Cells displaced outwardly into the interstitium evidenced degradation phenomena within the vacuoles, consisting of lamellar bodies or fingerprint-like inclusions, presumably the result of fusion of lysosomes with the lipidic inclusions.
If we were to look to the edges of the sample, then we would find scattered non- lipidized mononuclear histiocytes with abundant profiles of smooth-surfaced endoplasmic reticulum, possibly representing a reserve population of monocytes for conversion into xanthoma cells. (This is why recurrence of the condition is such a common feature).
Xanthelasma under the microscope.
Histopathologic findings of a patients Xanthelasma Palpebrarum. With image A, we can see the pale areas containing foamy cells are dispersed throughout the dermis (H&E Staining, ×40).
With image B we can see the Xanthoma cells. These foamy histiocytes are polygonal or rounded with a distinct cell membrane. Their nuclei are small and eccentric and their cytoplasms are stuffed with lipid vacuoles (black arrowheads) (H&E, ×400).
Xanthelasma Palpebrarum recurrence
Xanthelasma Palpebrarum has the ability to recur due the fact that, if treated incorrectly, it will reappear due to other cells potentially being at other stages of manifesting towards conversion of the cell to Xanthelasma Palpebrarum.
Tests for Xanthelasma
Characteristic appearance on physical examination As the Xanthelasma definition states, these lesions appear as planar, yellow-to-gray plaques present on the eyelids and the periorbital epidermisSerologic tests
Carrying out a fasting lipid level test can readily determine whether a patient’s xanthelasma was a consequence of hyperlipidemia in the first place. Clinicians should test patients with xanthelasma,
particularly if they are young or have multiple family histories with early on atherosclerotic disease.
The positioning of xanthelasma creates a confusion. One significant differential diagnosis is an appendageal tumor. It is important to rule out any malignancy and this is best done by examining the tissue under a microscope.
Who is vulnerable to this Disease?
As the Xanthelasma definition implies, it can happen in a number of hereditary disorders of lipoprotein metabolism including homozygous and heterozygous familial hypercholesterolemia, familial dysbetalipoproteinemia (type III), and in systemic disease.
What is the reason for the surface plaque exposure?
Many times it is the lipid that is at the root of this disorder, as is evident by the xanthelasma definition. There may be good proof that the lipid found within xanthomas is the same lipid circulating in high concentrations in the plasma of patients.However, the precise mechanisms that result in xanthoma development are less clear. It’s been proven that scavenger receptors for low-density lipoprotein (LDL), present on macrophages can take-up lipid.
This converts them into foam skin cells. It has additionally been proven that extravasated lipid can produce foam skin cells by inducing vascular endothelial receptors. Furthermore, oxidized low-density lipoprotein has been proven to be involved in the creation and infiltration of foam skin cells within the dermis.
Local factors like temperature, activity, and friction may increase LDL leakage from capillaries. This further aggravates the condition.
Systemic Implications and Complications
The basic xanthelasma definition should allow the clinician to check for complications of hyperlipidemia. These patients should be screened for lipid abnormalities and also have vigilant treatment of their lipid derangement to decrease the development of atherosclerotic disease. This is necessary to reduce the vascular and in turn heart, thrombotic, clotting and organ complications of deranged lipid levels.
- Lesions occur symmetrically on higher and lower eyelids.
- Lesions are delicate, yellow papules or plaques.
- Lesions start as small bump and slowly but surely grow greater over almost a year.
- As demonstrated in the image, left to thier own devices, xanthelasma on the cheek and xanthelasma on the nose, can be a possible outcome.
- May or may not be associated with hyperlipidemia.
- Firm, uncomplicated, red-yellow nodules that develop about the pressure areas including the knees, elbows, and buttocks. These are a little different than the typical xanthelasma definition but follow the same pattern.
- Lesions can accumulate together to create multilobulated masses
- Usually associated with hypercholesterolemia (increased cholesterol levels in blood vessels) and increased LDL levels.
- These xanthomas are firm swellings that lie deep in the subcutaneous layer of the skin.
- Appear as gradually enlarging subcutaneous nodules related to the tendons or ligaments
- The yellow plaques as stated in the xanthelasma definition occur most commonly in the hands, feet, and Calf muscles.
- Connected with severe hypercholesterolemia and enhanced LDL levels.
- They are primarily attached to tendons and are commonly found at the Achilles tendon at the ankle and the extension tendons of the fingers.
Diffuse plane xanthomatosis
- An exceptional form of histiocytosis that is different from the typical xanthelasma definition.
- Caused due to an unusual antibody in the bloodstream called a paraprotein.
- Lipid levels are normal.
- About 50% will have a malignancy of the blood vessels; usually multiple myeloma or leukemia.
- Presents with large level reddish-yellow plaques over the facial skin, neck, breasts, and buttocks and in skin folds (like the armpits and groin).
- Lesions typically erupt in groups of small, red-yellow papules
- Most commonly come up on the buttocks, shoulders, legs, and arms but might occur all around the body
- Rarely the facial skin and the mouth area may be affected
- Lesions may be sensitive and usually itchy
- Strong link with hypertriglyceridemia (increased triglyceride levels in bloodstream) often in patients with diabetes mellitus.
- Lesions are flat papules or areas that may appear anywhere on your body
- Lesions on the creases of the hands are indicative of consistent levels of increased lipids in blood vessels called type III dysbetalipo-proteinemia
- Could be associated with hyperlipidemia and hypertriglyceridemia.
- Combined with tuberous xanthomas is indicative of type 3 dysbetalipoproteinemia.
- Xanthoma-like lesions anticipated to an uncommon form of histiocytosis.
- Lipid metabolism is normal.
- The skin lesions are a huge selection of small yellowish-brown or reddish-brown bumps, which can be cover the facial skin and trunk. They could particularly have painful consequences on the armpits and groins.
- The tiny bumps can link with one another and form sheets of thickened pores and skin.
All of these different types of xanthomas signify that the disease can present in a variety of ways. However, usually, the primary xanthelasma definition remains true for all. Although the condition itself doesn’t have consequences other than cosmetic problems, you do need to consider the lipid manifestations.
The disease requires proper work up to prevent the lipid complications. Plus, the plaque itself can be removed easily. However, unless the lipid levels are controlled there is a high risk of recurrence.
Xanthelasma under the microscope.
The hallmark histopathologic feature of most xanthomas is the occurrence of foam skin cells within the dermis. These skin cells represent macrophages that have accumulated lipid. These skin cells will stain positive for lipid with special staining (Oil-red-O). According to the location of the plaque and the specific location of the foam cells, a histologic specimen of Xanthelasma can contain striated muscle, hairs or just epidermis.
Skin samples showing the Xanthoma cells.
One of the most common causes of Xanthelasma on the eyelids is in people suffering with both primary and secondary hyperlipidemia (elevated levels of any or all lipids and/or lipoproteins found in the blood).
If you have been diagnosed with altered lipoprotein composition or structure, such as lowered high-density lipoprotein (HDL) levels or type II hyperlipidemia in the type IV phenotype, you are more likely to suffer from Xanthelasma.
Are Xanthelasma dangerous?
While the Xanthelasma patches are not harmful themselves, they can be indicative of more serious problems, such as heart disease and high levels of cholesterol. If you do not have a family history of Xanthelasma, they can be an indication of high cholesterol. They might be correlated with a risk of heart disease, and so it is always a good idea to have them examined by your GP to rule out any further problems.
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