Xanthelasma And Xanthomas

Xanthoma and xanthelasma are closely related: xanthoma is the umbrella name for fatty deposits in the skin or tendons, and xanthelasma is the most common type, the soft yellow patches that form on the eyelids. This guide explains every type in plain English, what each can mean for your health, and what you can do about them.

What Is The Difference Between Xanthoma And Xanthelasma?

A xanthoma is any build-up of fat-filled cells in the skin or tendons, and it can appear almost anywhere on the body, from elbows and knees to the backs of the heels. Xanthelasma is a xanthoma on the eyelids. It’s the most common type by far, it’s usually soft and flat, and around half of people who have it have normal cholesterol.

Other types of xanthoma are less common and are more often a sign of a problem with blood fats, such as very high cholesterol or triglycerides, diabetes or an inherited condition. That’s why any xanthoma away from the eyelids should be checked by a doctor, who can arrange blood tests and the right care.

What Is Xanthoma?

Inside a xanthoma are foam cells: white blood cells called macrophages that have swallowed so much fat, mostly cholesterol, that they look foamy under a microscope. These cells gather in the skin or in tendons and form patches, bumps or lumps that are usually yellow, orange or skin-coloured. The word itself comes from the Greek for yellow.

Xanthoma skin changes are usually painless, though some types can be tender or itchy. They range from tiny dots to lumps several centimetres across, and they can appear on their own or in groups. Some appear suddenly and fade once blood fats come down; others grow slowly over years and stay unless they’re removed.

Doctors usually recognise them by their look and position, and may take a small sample or arrange blood tests to confirm what’s behind them.

Where Do Xanthomas Appear?

Xanthomas can form almost anywhere, but each type has favourite spots. Xanthelasma sits on the eyelids, usually near the inner corners. Tuberous xanthomas like pressure points such as elbows, knees and knuckles. Tendon xanthomas grow in the tendons at the backs of the heels and on the backs of the hands. Eruptive xanthomas appear in crops on the buttocks, shoulders, arms and thighs, and plane xanthomas spread flat in skin creases, on the palms or across the neck and trunk.

They can be a single patch or many, and they’re often symmetrical, appearing on both sides of the body. Where a xanthoma appears is one of the biggest clues to which type it is, and so to what may be causing it. How quickly it appeared is another. If you’ve noticed yellow patches or lumps anywhere other than your eyelids, take a photo and show your GP, who can check your blood fats and refer you to a specialist if needed.

The Main Types Of Xanthoma

Doctors group xanthomas by how they look and where they appear: xanthelasma, tuberous, tendon, eruptive, plane and the rare xanthoma disseminatum. Each is explained below, with what it looks like, what tends to cause it and what usually happens next. Knowing the type helps your doctor decide which blood tests to arrange. You can compare real examples in our xanthomas photos, and see how each type differs.

What Are The Main Causes Of Xanthomas?

Most xanthomas come down to fat in the blood, either too much of it or a problem with how the body handles it. Knowing the type of xanthoma, where it is and whether it appeared quickly or slowly helps your doctor decide which tests to run. The main causes are:

Inherited conditions such as familial hypercholesterolaemia and familial dysbetalipoproteinaemia, which keep blood fats high from early in life.

Conditions that raise blood fats, including diabetes, an underactive thyroid, some liver and kidney conditions, and obesity.

Lifestyle factors, such as heavy drinking and a diet high in saturated fat or sugar.

Certain medicines, including some hormone tablets, retinoids and steroids.

Rare conditions not linked to blood fats, such as xanthoma disseminatum and some blood conditions.

Xanthelasma is the exception that often doesn’t fit: about half of people with it have normal blood fats. Whatever the type, the first step is the same: a check-up with your GP and a blood test. If a cause is found, managing it protects your heart and may help xanthomas on the body shrink.