EpistemisXanthelasma
Specialty: Skin.
Why it occurs
- Familial hypercholesterolemia or primary dyslipidemia (focal deposition of cholesterol esters within dermal macrophages in the periorbital region)
- Primary biliary cirrhosis (important secondary cause of severe hypercholesterolemia due to chronic cholestasis)
- Idiopathic or normolipemic xanthelasma (present in a percentage of patients with normal lipid levels but local alteration in vascular permeability)
- Decompensated diabetes mellitus associated with metabolic syndrome
- Obesity and severe sedentary lifestyle with long-standing mixed dyslipidemia.
Initial workup
Complete fasting lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, apolipoprotein B). Complete liver function tests to rule out cholestasis or underlying chronic liver disease, and fasting blood glucose.
red flags
Presence of large bilateral xanthelasmas associated with chest pain on exertion, moderate intensity dyspnea, auscultable carotid murmurs or a history of myocardial infarction at an early age in first-degree relatives (suggestive of premature coronary heart disease due to familial hypercholesterolemia).
Standard management
- Atorvastatin — HMG-CoA reductase inhibitor of first choice for the strict control of underlying systemic hypercholesterolemia, doses of 20 to 80 mg daily orally
- Rosuvastatin — high potency alternative to reduce LDL-cholesterol levels, doses of 10 to 40 mg daily
- Ezetimibe — cholesterol absorption inhibitor as an adjuvant if lipid goals are not achieved with statins
- Referral to a specialist for localized physical removal using electrodessication, chemical peeling with 50% trichloroacetic acid or CO2 laser treatment if aesthetic resolution is preferred.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Skin
- Listed causes
- 5
- Treatment options
- 4