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Understanding Xanthelasma – yellow lumps on the eyelids.

Understanding Xanthelasma – yellow lumps on the eyelids explains the condition and the treatment options.

Xanthelasma (XP) is a condition where yellow lumps pop up on the eyelids. It’s quite common, affecting around 4% of people. Women tend to get it more, with an incidence of 1.1%, compared to 0.3% in men. Typically, it shows up between ages 15 and 73, peaking in the fourth and fifth decades.

About half of the cases may be linked to high cholesterol. If someone gets it before 40, they should get screened for inherited lipid metabolism disorders. The exact cause isn’t fully understood, but it involves the build-up of fatty tissue and cells called foam cells in the skin layers, causing inflammation.

Understanding Treatment Options

Chemical Peel – TCA (Trichloroacetic Acid)

  • TCA is applied on the xanthelasma at concentrations of 50%–100%.
  • It’s spread in a circular manner, focusing on the lesion’s edge.
  • The treated area is neutralized with sodium bicarbonate.

Studies found TCA 70% to be effective, especially for papular lesions. TCA 50% is good for macular xanthelasma. TCA therapy is more effective for smaller lesions, but repeated sessions may cause pigmentation and scarring.

Treatment of xanthelasma with fractional plasma

In a study using Plasmage, a plasma-based device, 50 patients had their xanthelasmas removed with excellent cosmetic outcomes. No scars remained, and patients experienced minimal side effects like temporary swelling and crusts. This non-invasive procedure shows promise not only for xanthelasma but also for other benign facial lesions. Although more studies are needed, the initial clinical experience is positive. (Cheles D, Esperienze Dermatol 2021;23:1-6. DOI: 10.23736/S1128-9155.21.00513-6).

Liquid Nitrogen Cryotherapy

  • Simple and effective treatment.
  • Generally avoided near the eye due to swelling risk.
  • Short freeze times can be used, with a case series reporting no recurrences in a 10-year period.


  • An antibiotic used intralesionally.
  • Showed satisfactory results in treating xanthelasma with minimal complications.

Radio-frequency Ablation

  • Low-voltage radio-frequency used in a study with 9 out of 15 patients showing improvement.
  • Effective for lesions close to the eye and those with indistinct borders.
  • Another study compared it to TCA, showing similar improvement scores, but RF ablation had more complications.

Laser Ablation CO2 Laser

  • Gold-standard ablative laser, vaporizes skin layer by layer.
  • Studies report excellent outcomes with minimal scarring.
  • CO2 laser compared to TCA and other treatments showed good results, but recurrence rates vary.

Er: YAG Laser

  • Ablative laser with a smaller thermal coagulation zone than CO2.
  • Faster healing time with no associated scarring in studies.

Q-switched Nd: YAG Laser

  • Results vary; some report good responses, while others show poor clearance.
  • High dropout rate reported due to disappointing results in some studies.

Argon Laser

  • Alternative laser treatment with good cosmetic outcomes.
  • Minimal complications reported in studies.

Potassium Titanyl Phosphate (KTP) Laser

  • Works on the principle of selective photothermolysis.
  • One study reported an efficacy of 85.7% without side effects.

Pulsed Dye Laser

  • Promising results reported with the majority achieving greater than 50% clearance.
  • Side effects include purpura, edema, and post-inflammatory hyperpigmentation.

Diode Laser (1450-nm)

  • Previously used, photothermal destruction of sebaceous glands.
  • Showed 40%–80% clearance with minimal side effects in studies.

Each treatment option has its advantages and considerations. Consultation with a healthcare professional is recommended to determine the most suitable approach based on individual factors and preferences.

Surgery for Xanthelasma – yellow lumps on the eyelids.

Traditionally, surgeons have been the unsung heroes in the battle against xanthelasma. Surgical excision, a fancy term for removal, has been the go-to method, often delivering impressive cosmetic results. Picture it as a makeover for your eyelids!

Now, there are different surgical techniques in this beauty arsenal. The classic blepharoplasty, a bit like the VIP treatment for your eyelids, delicately cuts away the xanthelasma in stages. On the other hand, there’s Le Roux’s technique, a modified blepharoplasty approach – it’s like the eyelid spa treatment.

But, here’s the catch: Xanthelasma is a bit of a rebel. It likes to come back and play, with recurrence rates as high as 40% and 60% after the first and second removal attempts.

What the literature review showed?

They reviewed 95 cases, treating 70% with a simple excision and blepharoplasty combo and the remaining 30% with a mix of excision, local flaps, or skin grafts for the more advanced cases. Results were pretty good, with only a 3.1% recurrence at 12 months. They also spilled the tea that recurrence rates spike when the excision isn’t thorough – up to 40% for the first round, 60% for the second, and a whopping 80% if both upper and lower eyelids are in on the game.

So, what’s the takeaway? Surgical excision, especially for those deep-seated xanthelasma rebels, seems to be the way to go. It’s like giving them an eviction notice, making sure they don’t come back for a surprise visit. Other surgical techniques, like a combo of surgery and chemical peeling, are in the playbook too. Think of it as a tag team match against those pesky yellow patches.

Remember, your eyelids are your canvas, and these surgeons are the artists ensuring a masterpiece! If you’re considering this path, a chat with the experts might just be your first step to fabulous, xanthelasma-free lids.

Closing Thoughts on Xanthelasma

Even though Xanthelasma Palpebrarum (XP) is generally harmless, it can really mess with your head because of how it affects your appearance.

In about half the cases, XP signals an issue with the fats in your blood. It’s like a red flag saying, “Hey, check your cholesterol!” So, it’s smart to screen for any potential underlying problems and keep an eye on your health.

Good news: XP doesn’t usually interfere with how your eyes work, but many folks opt for treatment just to jazz up their looks. The not-so-great news: no matter how you tackle it – be it with lasers, surgery, or other tricks – XP has a knack for coming back. We’re still on the lookout for that one-size-fits-all solution.

In a nutshell, while XP might be a bit of a cosmetic bother, there’s ongoing research to find the golden ticket for a lasting fix. For now, it’s a journey of trial and error to keep those yellow patches at bay. Stay tuned for what the future holds in the quest for flawless lids!


Laftah Z, Al-Niaimi F. Xanthelasma: An Update on Treatment Modalities. J Cutan Aesthet Surg. 2018 Jan-Mar;11(1):1-6. doi: 10.4103/JCAS.JCAS_56_17. PMID: 29731585; PMCID: PMC5921443.

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