Xanthelasmas, a Side Effect of High Cholesterol Levels

Did you know that high cholesterol (hypercholesterolemia) can make itself known on your face and around your eyes? 

You may have noticed “bumps” on your eyelids or around the eyes of others and wondered what on earth are those? They are called xanthelasmas. Xanthelasmas are soft, cholesterol-filled raised “bumps” that develop under the skin, on or around your eyelids, and close to your nose.

These yellow raised deposits are a side effect of having high levels of lipids in your blood. Xanthelasmas may not be harmful initially, but they can gradually worsen, cause pain, and detract from your good looks!

They may also signal a more serious underlying health problem.

We are bombarded with information on healthy eating and on maintaining a healthy lifestyle. We’ve heard about the impact of cholesterol on our hearts and the importance of keeping our cholesterol in check. 

Medical professionals constantly caution us against eating certain foods, and we are encouraged to consume the foods that will help to lower our cholesterol levels. 

What are xanthelasmas?

They are raised yellowish papules caused by the localized accumulation of lipid deposits commonly seen around the eyelids.

They occur in approximately 4% of the population. Xanthelasmas are prevalent in 1.1% in females and 0.3% in males. 

These eye deposits can begin to make their appearance between the ages of 15 and 73 years, although an increased appearance is usually seen during the fortieth and sixtieth years of life.

More than 50% of these cases are associated with underlying hyperlipidemia. These fatty deposits also gradually become larger over time and begin to cause discomfort.

If these cholesterol deposits present prior to the age of 40 years, it requires a prompt screening by your physician to rule out any acute underlying inherited disorders of lipoprotein metabolism.

The Role of Genetics

Genes are powerful, they play a major role in who, how, and why we function the way we do. Another huge component is nature versus nurture. We often inadvertently learn habits that are are not the best for the genes we inherited. Familial hypercholesterolemia is an inherited trait characterized by very high levels of cholesterol in the blood.

In the case of hypercholesterolemia, the foods we eat along with our genetic predisposition can wreak havoc on our physical bodies and our mind.

Cholesterol & Our Circulatory System

High cholesterol can predispose us to develop a form of heart disease called Coronary Artery Disease (CAD) at a young age.

Coronary Artery Disease develops when excess cholesterol is in the bloodstream and deposits in the walls of our blood vessels, particularly the arteries that supply blood to the heart (coronary arteries).

This buildup of cholesterol forms clumps (plaques) that narrow and harden the arterial walls. This, of course, presents issues when these vessels need to be pliable and malleable to allow blood and nutrients and the elimination of waste.

If the vessels harden a myriad of health issues will follow.

Causes of Xanthelasmas

Anyone may get cholesterol deposits around their eyes. But this condition is most common in people with a lipid disorder called dyslipidemia.

People with this disorder have too many lipids in their bloodstreams, such as triglycerides and certain forms of cholesterol.

You may have dyslipidemia if you have any of the following conditions:

• hypercholesterolemia, identified by total cholesterol greater than 200 milligrams per deciliter (mg/dL)
• hypertriglyceridemia, identified by triglycerides above 150 mg/dL
• high levels of low-density lipoprotein (LDL), also known as bad cholesterol, identified by LDL above 100 mg/dL
• high levels of high-density lipoprotein (HDL), also known as good cholesterol, identified by HDL above 40 mg/dL

There are various other factors that can cause you to have too many lipids in your bloodstream, and in turn, you can develop xanthelasma around your eyes. Some causes are genetic, meaning you cannot do much to prevent them. Other causes are the result of lifestyle choices or the side effects of some medications.

Genetic causes may include:

• deficiency of familial lipoprotein lipase, the enzyme that breaks down lipids
• familial hypertriglyceridemia, a genetic condition that causes people to have higher amounts of triglycerides in their blood
• familial dyslipoproteinemia, a genetic condition that causes people to have higher amounts of lipids in their blood.

Foods to Eat in Moderation

Cholesterol is a waxy, fat-like substance that is produced in the body and obtained from foods that come from animals (particularly egg yolks, meat, poultry, fish, and dairy products). The body needs this substance to build cell membranes, make certain hormones, and produce compounds that aid in fat digestion.

In people with familial hypercholesterolemia, the body is unable to get rid of extra cholesterol, and it builds up in the blood. Too much cholesterol increases a person’s risk of developing heart disease.

Lifestyle factors may include:

• diets high in saturated fats and low in unsaturated fats
• excess alcohol consumption
• lack of cardiovascular exercise
• weight gain
• a diet low in fiber
• smoking

Medications that may increase your risk for developing cholesterol deposits around your eyes include:

• beta-blockers
• oral contraceptives
• estrogen-containing medications
• corticosteroids
• retinoids
• thiazide diuretics
• protease inhibitors
• anabolic steroids
• antiepileptic drugs

Some conditions such as kidney disease, hypothyroidism, and diabetes mellitus can also contribute to the development of cholesterol deposits. That’s because these conditions can increase lipid concentration in your blood. Often the cause of dyslipidemia is unknown.

How is it Diagnosed?

Your doctor will ask you when you first noticed the yellow spots and whether they’ve changed since you noticed them. They may be able to make a diagnosis from a visual exam because xanthelasma has a distinctive appearance.

Your doctor may also want to know if you have a medical history of dyslipidemia. They may look for risk factors of the condition such as diet and genetics. They may also do a blood panel test to determine your lipid levels.

Treatment for cholesterol deposits around your eyes

Your doctor may be able to remove the cholesterol deposits. There are a few different methods they may use:

• Surgical excision using a very small blade is typically the first option to remove one of these growths. Recovery is at least four weeks.
• Chemical cauterization uses chlorinated acetic acids and can remove the deposits without leaving much scarring.
• Cryotherapy used repeatedly can destroy xanthelasma. This carries the risk of scarring and changes to the pigment of your skin.
• Carbon dioxide and argon laser ablation is less invasive than surgery and has a reasonable success rate. It carries the risk of pigmentation changes.
• Electrodessication can be used with cryotherapy.

For any procedure, it’s important to monitor your recovery. Note any side effects you experience, and let your doctor know about them at your next appointment.

Xanthelasma has a high recurrence rate, especially in cases of surgical excision or severe hyperlipidemia.So watch that cholesterol!

The underlying cause of xanthelasma may be dyslipidemia, so your doctor may also recommend lifestyle changes to help manage lipids in your bloodstream. That’s because the underlying cause of xanthelasma may be dyslipidemia. Controlling the number of lipids in your blood may help reduce your risk of developing future deposits.

• Work with a dietitian to evaluate your diet and come up with a plan for any changes you may need to make.
• Limit the number of saturated fats you eat to fewer than nine percent of your daily calorie intake.
• Increase your intake of fiber.
• Eat more protein, especially plant proteins that contain fewer calories, lower fat, and more fiber. Some examples of plant-based protein include tofu or beans.
• Reduce alcohol intake. Women should have no more than one drink per day, and men should have no more than two. A drink is defined as 5 ounces of wine or 12 ounces of beer.
• If you smoke or chew tobacco, think about quitting. Talk to your doctor about programs to quit smoking if you need help breaking the habit.
• Eat a moderate number of calories from monounsaturated and polyunsaturated fats.
• Participate in 30 minutes of moderate-intensity cardiovascular exercises three times per week.
• Do resistance exercises twice per week.

Your doctor may also prescribe medication that manages triglycerides or cholesterol.

Outlook

Xanthelasmas result from fatty deposits that build up around your eye. It can occur in people of all ages, but most often occurs in middle-aged and older adults. Xanthelasmas are generally not painful, but they can gradually build up and cause more discomfort if left untreated.

Xanthelasma can be treated through a variety of techniques. Your doctor may also recommend creating a plan that addresses the underlying cause of it, which is often dyslipidemia.