Makindo Medical Notes

🟡 Xanthelasma (eyelid cholesterol plaques)

• Soft, yellowish, flat or slightly raised plaques on the medial upper/lower eyelids.
• Benign and often asymptomatic, but a visual cue to check lipids & cardiovascular risk.
• Spelling: xanthelasma (not “xanthelamas”).

🧭 Causes & Associations

• 📈 High cholesterol (↑ LDL) and/or high triglycerides.
• 🩺 Diabetes / metabolic syndrome.
• 🦋 Hypothyroidism.
• 💚 Primary Biliary Cholangitis (PBC) and other cholestatic liver disease.
• 🧬 Familial dyslipidaemias (e.g., familial hypercholesterolaemia).
• 🧪 Sometimes occurs with normal lipids (idiopathic), especially with age.

🧑‍⚕️ Assessment (primary care)

• History: onset, growth, prior lipid results, CVD risk factors, family history of early MI/stroke or tendon xanthomas, alcohol, diet, meds (e.g., retinoids, antiretrovirals).
• Exam: eyelid plaques; look for tendon xanthomas, corneal arcus (<45 yrs), hepatomegaly, stigmata of cholestasis.
• Tests:
  • Fasting/non-fasting lipid profile (TC, LDL-C, HDL-C, TG; consider non-HDL-C).
  • HbA1c / fasting glucose; TSH; LFTs (if cholestasis suspected).
  • Consider secondary causes (nephrotic syndrome, hypothyroidism, PBC).
• Risk: calculate 10-year ASCVD risk (QRISK in UK) to guide lipid-lowering therapy.

🩹 Management

• 🎯 Treat the underlying dyslipidaemia and cardiovascular risk (lifestyle + statin first-line; add ezetimibe/PCSK9i in specialist care if indicated).
• 🍏 Lifestyle: diet quality (↓ saturated fat, ↑ fibre/plant sterols), weight, exercise, limit alcohol (esp. if TG high), stop smoking.
• 👁️ Cosmetic removal (if desired or symptomatic): cryotherapy, electrocautery, chemical cautery (e.g., TCA), laser (CO₂/Er:YAG), or surgical excision. Recurrence is common.
• 🧴 Gentle peri-ocular skin care; warn about post-procedure pigment change/scar risk; refer to oculoplastics/derm if near lid margin.

🚩 Refer / Seek Specialist Advice

• Very high LDL-C, tendon xanthomas, strong family history → consider familial hypercholesterolaemia (lipid clinic).
• Features of cholestasis or abnormal LFTs → hepatology work-up (consider PBC).
• Cosmetic removal near canthus/lid margin → oculoplastics/dermatology.

🗣️ Patient-friendly message

“These soft yellow eyelid patches are called xanthelasma. They’re harmless, but they can be a sign of higher cholesterol. We’ll check your lipids and general heart risk and support you with treatment. If the patches bother you, safe removal options exist— but they can come back, so treating cholesterol is still important.”

📚 Quick List (for cards)

• High cholesterol • High triglycerides • Diabetes • Hypothyroidism • Primary Biliary Cholangitis