Xanthelasma

𝘠𝘦𝘭𝘭𝘰𝘸 𝘭𝘪𝘥𝘴!⁣

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𝗫𝗮𝗻𝘁𝗵𝗲𝗹𝗮𝘀𝗺𝗮⁣

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Benign cutaneous lesions around the periocular area⁣

More common in women⁣

30-50 years of age⁣

Associated lipid disorders⁣

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Risk factors⁣

Diabetes mellitus⁣

Hypothyroidism⁣

Cardiovascular disease⁣

Obesity⁣

Pancreatitis⁣

Hyperuricemia⁣

Smokers⁣

Excessive alcohol intake⁣

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Pathophysiology⁣

Increased plasma peroxidation of low density lipoprotein (LDL) resulting in cholesterol accumulation within macrophages to form foam cells⁣

In xanthoma formation, the ability to remove cholesterol from the tissue is reduced due to low HDL levels⁣

The rate at which LDL leaks from the capillaries is increased in areas that have more friction and are in constant motion (so eyelid skin is most commonly affected)⁣

An increase in inflammatory cells within the eyelid tissue is also thought to have an effect on the formation of xanthelasma⁣

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Features:⁣

Most common site: Medial canthus. More in upper lid⁣

Soft, yellow papules or plaques filled with cholesterol⁣

Multiple, symmetric lesions⁣

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HPE:⁣

Reticular dermis infiltration of foamy macrophages with sparing of the epidermis, papillary dermis, and subcutaneous fatty layer⁣

Inflammatory infiltrate in the superficial reticular dermis will be perivascular and consist of foam cells with lipid-laden cytoplasmic vacuoles⁣

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Systemic Investigations⁣

HbA1C⁣

LFT⁣

Thyroid function tests⁣

Lipid profile⁣

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Rx⁣

Conservative: Low-fat diet, Statins⁣

Surgical excision⁣

Laser therapy: Coagulates vessels and damages the perivascular foam cells that⁣

make up the lesion. Fractionated Er:YAG and fractionated CO2 lasers are used⁣

Chemical peel: With Tricholoroacetic acid (70% concentration)⁣

Peel induces a chemical cauterization causing coagulation of proteins within the⁣

skin- this is then neutralized within the superficial dermal plexus⁣

Effective on small lesions⁣

Cryotherapy: causes vasoconstriction and the formation of microthrombi as a result of cell death within XP lesions Now avoided because of high risk of eyelid swelling.⁣

Radiofrequency ablation: electrocoagulation for instant hemostasis and is used in vascular lesions. For lesions that are very close to the globe or have indistinct borders.⁣

www.ophthalmobytes.com⁣

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