Clinical Challenge: Growth Under Eyes - MPR

Clinical Challenge: Growth Under Eyes

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A 51-year-old woman requested removal of growths under both eyes. The lesions have been slowly increasing in size over the past 18 months and are asymptomatic. She is currently taking the diuretic hydrochlorothiazide and pravastatin. Upon physical examination, bilateral, whitish-yellow, and slightly raised plaques are observed. No similar lesions are noted elsewhere.

Xanthelasma palpebrarum are common lesions that arise in the periorbital region. The condition occurs predominately in women and rarely in men.1 In certain geographic regions the incidence may be as high as 1.5%.2 The peak onset is in the fourth and fifth...

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Xanthelasma palpebrarum are common lesions that arise in the periorbital region. The condition occurs predominately in women and rarely in men.1 In certain geographic regions the incidence may be as high as 1.5%.2 The peak onset is in the fourth and fifth decades.

Xanthelasma present as yellowish plaques in proximity to the medial canthus of the eyelid.  Diagnosis is usually made by observation. Histology is also characteristic revealing foamy histiocytes within the upper and mid dermis.3

Approximately 50% of patients with xanthelasma have elevated triglycerides.3 Some clinicians have suggested that the inflammatory components comprising xanthelasma palpebrarum resemble early stages of cardiac atherosclerotic plaques,4 hence the heightened impetus to recognize individuals with abnormal lipid and cholesterol levels.

Other than serving as a marker for potential cardiovascular disease, the lesions are unsightly and many patients seek removal for cosmetic enhancement. Surgical excision, topical trichloroacetic acid, and laser ablation are therapeutic options.5-7 Recurrence with any of these modalities is not uncommon.8

Stephen Schleicher, MD, is director of the DermDox Center for Dermatology in Pennsylvania, as well as an associate professor of medicine at Commonwealth Medical College and a clinical instructor of dermatology at Arcadia University and Kings College.

References

1.  Jónsson A, Sigfŭsson N. Letter: Significance of xanthelasma palpebrarum in the normal populationLancet. 1976;1(7955):372.

2.  Jain A, Goyal P, Nigam PK, Gurbaksh H, Sharma RC. Xanthelasma palpebrarum: clinical and biochemical profile in a tertiary care hospital of Delhi. Indian J Clin Biochem. 2007;22(2):151-153.

3. Bergman R. The pathogenesis and clinical significance of xanthelasma palpebrarum. J Am Acad Dermatol. 1994;30(2 Pt 1):236-242.

4. Govorkova MS, Milman T, Ying GS, Pan W, Silkiss RZ. Inflammatory mediators in xanthelasma palpebrarum: histopathologic and immunohistochemical study. Ophthalmic Plast Reconstr Surg. 2018;34(3):225-230.

5. Obradovic B. Surgical treatment as a first option of the lower eyelid xanthelasmaJ Craniofac Surg. 2017;28(7):e678-e679.

6. Cannon PS, Ajit R, Leatherbarrow B. Efficacy of trichloroacetic acid (95%) in the management of xanthelasma palpebrarumClin Exp Dermatol. 2010;35(8):845-848.

7. Nguyen AH, Vaudreuil AM, Huerter CJ. Systematic review of laser therapy in xanthelasma palpebrarumInt J Dermatol. 2017;56(3):e47-e55.

8. Wang KY, Hsu KC, Liu WC, Yang KC, Chen LW. Relationship between xanthelasma palpebrarum and hyperlipidemiaAnn Plast Surg. 2018;80(2S Suppl 1):S84-S86.