Xanthomas are deposits of fat filled foam or xanthoma cells in the superficial dermal layer of the skin often surrounded by scarring and inflammation. The condition of having them is called xanthelasma. About half of the patients with xanthelasma have a metabolic disorder with increased fat in the blood (Hyperlipoproteinemia type IIa – high blood cholesterol and LDL levels). The fat is transported in a protein capsule so the complex is called a lipoprotein. The treatment for this type of hyperlipoproteinemia is bile acid sequestrants, statins and niacin.
The treatment of xanthomas has been surgical removal of the material with or without overlying skin, laser treatments and chemical peels. The treatment decision tree depends on the size and number of xanthomas and whether they are hard or soft. Hard ones can be uncapped to remove the xanthoma and then the cap of skin is sutured back down. Smaller xanthomas closer to the lower eyelid lashes or upper eyelid creases can be removed with the skin at blepharoplasty. Larger xanthomas needed to be removed in a staged piecemeal fashion. With a 2 or more month interval between surgical excisions.
All xanthelasma patients should have their blood cholesterol and LDL levels checked and treated as needed to prevent recurrence of the xanthomas.