Xanthrasma Causes and Treatment of Yellow Spots Around the Eyes

Have you ever noticed small yellowish spots on your eyelid? These marks are not just a cosmetic issue; they might be an early sign of high blood fat levels or a metabolic disorder. This condition is known as xanthelasma, and it is more common among individuals with high cholesterol levels or a family history of lipid problems. In this article by , we will explore:

• The causes of xanthelasma and how to diagnose it

• The stages and symptoms of the condition that may go unnoticed

• Available treatment options, including laser therapy and surgery

• Prevention tips and how to reduce the chances of recurrence

Whether you're looking for a safe cosmetic solution or want to understand the health reason behind these spots, you'll find everything you need to know about xanthelasma and how to deal with it effectively.

Is Xanthelasma Dangerous?

No, xanthelasma is not a dangerous condition, but it can be an indicator of high blood fat levels in some people. The main concern is its effect on the appearance of the eyes, making them look less aesthetically pleasing.

Is Xanthelasma Contagious?

No, xanthelasma is not contagious. It is linked to high lipid levels or genetic factors, not caused by an infection.

Can Xanthelasma Go Away on Its Own?

Unfortunately, xanthelasma does not disappear on its own and may even grow larger over time. The only way to remove it is through appropriate cosmetic treatment.

Is Xanthelasma a Sign of Heart Problems?

Not always, but sometimes it indicates:

• High cholesterol

• Elevated triglycerides

• Lipid metabolism disorders

Therefore, it's recommended to get a full lipid profile when it appears.

Can Xanthelasma Return After Removal?

Yes, xanthelasma may return in some cases, depending on:

• Blood lipid levels

• The treatment method used

• Genetic factors

However, with proper treatment and controlling lipid levels, it often doesn't return.

Does Removing Xanthelasma Cause Scarring?

It depends on the treatment method:

• Laser: Scarring is very rare.

• Surgery: There may be a small scar.

• Electrocautery or Plasma: Temporary marks that usually disappear.

✅ Choosing an experienced doctor greatly reduces the chances of scarring.

Is Xanthelasma Painful?

Xanthelasma itself is not painful. During removal, local anesthesia is used, so the pain is minimal or nonexistent.

Can Xanthelasma Spread?

It can spread in cases of:

• High blood fat levels

• Genetic factors

• Delayed treatment

❌ It does not spread due to touching or poor care.

Can Xanthelasma Be Treated at Home?

No, there is no effective home remedy to remove xanthelasma. Natural remedies or creams can cause skin irritation or burns around the eyes.

Does Insurance Cover Xanthelasma Treatment?

Insurance usually does not cover xanthelasma treatment, as it is considered a cosmetic procedure unless the spot is very large and affects vision.

Can You Use Makeup After Removal?

You can use makeup after recovery:

• Laser or Plasma: After 5–7 days

• Surgery: After 7–10 days

Make sure the skin is fully healed with no scabs before applying makeup.

How Common Is Xanthelasma?

Xanthelasma is the most common type of cholesterol deposits on the skin, but it occurs in only about 1% of the population.

Can Xanthelasma Go Away on Its Own?

No, it will not disappear without treatment. It may stay the same size or grow over time.

❌ You cannot pop or squeeze it like a pimple. Over-the-counter products may cause burns or skin irritation.

How Long Does Recovery Take?

It depends on the treatment method:

• Quick recovery: 3–4 days for minor side effects

• Longer-lasting effects like skin discoloration or redness may take several weeks to months to fully disappear.

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What is Xanthelasma?

Xanthelasma is a yellow cholesterol deposit under the skin, typically appearing near the inner corner of the eyelid. These bumps can be flat or slightly raised and are generally benign but sometimes indicate high blood fats or heart issues.

• It doesn’t disappear on its own

• It may stay the same size or grow over time

• It has a soft, chalky texture, and is somewhat firm

• It can be removed through surgical, laser, or chemical peel methods.

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Types of Xanthelasma

Even though xanthelasma is known as yellow spots on the eyelids, there are different types depending on the shape, size, and depth of the deposits:

1. Superficial Xanthelasma

   • The most common type

   • Flat or slightly raised spots with a pale yellow color

   • Located just beneath the skin’s surface, usually on the upper eyelid

   • Easy to treat with laser or chemical peels

2. Deep Xanthelasma

   • Deposits are deeper inside the skin

   • Firmer texture and larger in size

   • Often extends into the dermal layers

   • Usually requires surgical removal as superficial treatments are ineffective

3. Nodular Xanthelasma

   • Less common, appears as lumps or nodules

   • Raised plaques, sometimes closely grouped

   • May increase in size over time

   • Often associated with high blood fats

4. Diffuse Xanthelasma

   • Large spots covering a broad area of the upper or lower eyelid

   • More common in older adults

   • May indicate metabolic disorders

   • Requires gradual or combined treatment (laser + surgery)

5. Secondary Xanthelasma

   • Caused by other diseases, not just high fats

   • Causes: Liver diseases, thyroid problems, uncontrolled diabetes

   • Treatment depends on addressing the underlying condition first

6. Normolipidemic Xanthelasma

   • Appears in over 40% of cases without elevated lipid levels

   • Similar in color and shape to other types

   • Blood tests for fats will be normal

   • Often linked to genetic factors, skin aging, or weakened skin

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Main Causes of Xanthelasma

Xanthelasma are yellow fatty deposits around the eyelids, often indicating lipid imbalance or an internal health problem. Although it seems like a cosmetic issue, the causes are usually linked to overall body health:

1. High LDL Cholesterol

   • The most common and significant cause

   • Elevated cholesterol leads to fat accumulation under the skin, particularly in the eyelids

   • Symptoms: Increased triglycerides, blocked arteries, chest pain, or shortness of breath in advanced cases

2. High Triglycerides

   • Elevated triglycerides directly contribute to the formation of yellow deposits

   • Causes: Excessive sugar intake, weight gain, fried foods, saturated fats, and lack of physical activity

3. Liver Disorders

   • Conditions like fatty liver disease, cirrhosis, or chronic hepatitis

   • When the liver fails to process fats, they accumulate in the blood and then under the skin

4. Genetics

   • Some individuals develop xanthelasma despite normal weight and a healthy lifestyle

   • Genetic disorders like familial hypercholesterolemia or inherited dyslipidemia

5. Diabetes Mellitus

   • Affects cholesterol and triglyceride levels

   • Elevated sugar levels increase the likelihood of developing xanthelasma

6. Hypothyroidism

   • Slower metabolism of fats due to underactive thyroid

   • Leads to elevated blood fat levels and the appearance of deposits under the skin

7. Obesity & Weight Gain

   • Increases triglycerides and LDL cholesterol

   • Linked to insulin resistance, which promotes xanthelasma formation

8. Unhealthy Diet

   • Fried foods, animal fats, fast food, and high sugars

   • Rapidly elevate fats and increase their deposition under the skin

9. Smoking

   • Accelerates fat oxidation in the blood

   • Speeds up fat accumulation and deposition under the skin

10. Rare or Genetic Disorders

• Conditions like type III hyperlipidemia or rare metabolic disorders

• Prevent the body from processing fats properly

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Stages of Xanthelasma

Xanthelasma develops gradually and can be divided into four main stages:

1. Early Stage

   • Very small spots, usually on the upper eyelid near the nose

   • Faint yellow color, size 1–3mm, very slight elevation

   • Painless, may take months before noticing

2. Moderate Stage

   • Spots grow larger and become more noticeable

   • Slight elevation, golden-yellow color, may spread horizontally

   • A second spot may appear beside it, and the cosmetic appearance starts to cause concern

3. Advanced Stage

   • Deposits cluster into large plaques, may extend to the lower eyelid

   • Firmer texture, can form into lumps

   • Superficial treatments become ineffective, requiring laser or surgery

4. Severe / Diffuse Stage

   • Widespread deposits, deeper into the skin

   • Large plaques cover much of the eyelid

   • May require full surgical treatment and is sometimes linked to liver problems or very high lipid levels

Symptoms of Xanthelasma Around the Eye

Xanthelasma typically doesn't cause pain or itching, but it appears prominently on the eyelid and can cause aesthetic discomfort. Its primary symptoms are related to changes in the skin around the eye due to fat deposits.

1. Yellow Patches Around the Eyelid
   The yellow spots or plaques usually appear on:

   • Upper eyelid

   • Inner corner of the eye

   • Occasionally, on the lower eyelid
     Their distinctive appearance makes them hard to confuse with other skin conditions.

2. Soft or Semi-Greasy Texture
   The plaques are often:

   • Soft to the touch

   • Slightly sticky at times

   • Smooth or slightly raised above the skin

3. Increase in Size Over Time
   If left untreated, they may gradually grow:

   • Starting from a very small spot

   • Developing into larger plaques covering the eyelid
     They remain painless.

4. Appearance on Both Eyelids
   Xanthelasma often appears on both eyelids. Sometimes, it starts on one side and then moves to the other.

5. Changes in Eyelid Shape or Mild Sagging
   In advanced cases, fat accumulation may lead to:

   • Mild sagging of the eyelid

   • Altered texture of the skin surface
     The condition remains painless or non-inflammatory.

6. No Pain or Itching
   Xanthelasma does not cause:

   • Pain

   • Burning

   • Redness

   • Itching
     This is why many people mistakenly believe it is just a cosmetic issue.

7. Possible Indicator of High Blood Lipids
   While xanthelasma itself is not harmful internally, it could signal:

   • High cholesterol

   • Elevated triglycerides

   • Thyroid disorders

   • Liver diseases
     Doctors recommend lipid tests when it appears to assess overall health.

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Risks of Improperly Handling Xanthelasma

Although xanthelasma consists of superficial, non-painful fat deposits, improper handling—such as pressing, rubbing, or attempting to "pop" it—can cause serious skin issues since it is not a "pimple" or cyst that can be squeezed.

1. Increased Inflammation and Redness
   Pressing or rubbing can irritate the skin:

   • Redness

   • Mild warmth

   • Pain upon touch

   • Swelling
     Inflammation may cause the spot to enlarge and become more noticeable.

2. Thickening of the Xanthelasma
   Repeated trauma stimulates the skin to form fibrous scar tissue around the fat deposits, leading to:

   • Increased size of the xanthelasma

   • Greater elevation from the skin surface

   • Difficulty in treating it with laser later

3. Change in Color and Pigmentation Around the Spot
   Excessive pressure can break small blood vessels under the skin:

   • Bruising

   • Darkening of the area

   • Uneven skin tone around the spot

4. Small Cuts Leading to Permanent Scarring
   Attempting to "pop" or open it with nails or unsterilized tools can result in:

   • Deep scratches

   • Superficial wounds

   • Permanent dark scars or deformities
     Especially as the eyelid skin is very thin and prone to tearing.

5. Increased Risk of Infection
   Using unclean tools or applying too much pressure can introduce bacteria into the skin:

   • Bacterial infection

   • Pus and severe pain

   • Antibiotics may be required
     In severe cases, this can leave permanent marks.

6. Faster Spread of Xanthelasma
   Repeated skin trauma can stimulate the body to store more fat:

   • Faster growth of the spot

   • Formation of new spots around it

   • Spread to the other eyelid in some cases

7. Reduced Effectiveness of Treatments Later
   Skin that is repeatedly traumatized becomes:

   • Thicker

   • Less responsive to laser treatment

   • May require more sessions, or surgery may become the only solution

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Medications for Xanthelasma: How to Reduce and Prevent Its Worsening

Xanthelasma is caused by yellow fat deposits around the eyelids, often due to high cholesterol, triglycerides, or metabolic fat disorders. Medications do not remove the patches themselves but address the underlying causes and prevent new spots from appearing or existing ones from growing.

1. Cholesterol-Lowering Drugs (Statins)
   The most common medications for treating the root cause: high LDL cholesterol.

   • Examples: Atorvastatin, Rosuvastatin, Simvastatin
     Benefits:

   • Reduces LDL (bad cholesterol)

   • Prevents fat accumulation under the skin

   • Decreases the chances of new xanthelasma
     Limitations: Does not completely remove the current spot, but may reduce its size over time.

2. Triglyceride-Lowering Medications (Fibrates)
   Used when triglyceride levels are elevated.

   • Examples: Fenofibrate, Gemfibrozil
     Benefits:

   • Significantly reduces triglycerides

   • Limits fat accumulation in the eyelids

   • Prevents new spots from forming
     Limitations: Does not make the spot disappear completely.

3. Ezetimibe
   Reduces fat absorption in the intestines.
   Benefits:

   • Significantly lowers LDL cholesterol

   • Often used with statins when lipid levels are very high

   • Prevents new xanthelasma from appearing

4. Natural Medications (Omega-3)
   Suitable for mild to moderate fat elevation.

   • Examples: Omega-3, Fish oil, EPA/DHA
     Benefits:

   • Reduces triglycerides

   • Reduces inflammation

   • Supports fat management
     Limitations: Weaker effect compared to chemical medications.

5. Topical Creams and Skin Peels (Not Very Effective)
   Some studies suggest that TCA creams or chemical peels might help a little, but:

   • They do not remove xanthelasma from the root

   • May cause irritation or scarring

   • Require professional medical supervision
     Note: Not recommended as the primary treatment.

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Xanthelasma Treatment: All Methods by Laser and Surgery

Medications alone will not remove xanthelasma ❌, but they are important because they prevent worsening, protect the heart and arteries, and reduce the chances of new spots appearing. To permanently remove the patches, methods like laser, surgery, chemical peels, plasma, or radiofrequency cautery are used.

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Laser Treatment (Laser Treatments)

Laser treatment is one of the most popular and effective methods for removing xanthelasma without major surgery or noticeable scarring.

1. CO2 Fractional Laser
   This laser vaporizes fat deposits with high precision without affecting healthy skin.
   Advantages:

   • Extremely precise

   • Suitable for most cases

   • Minimal scarring

   • One session is usually enough
     Disadvantages:

   • Mild redness and inflammation for 5–7 days

   • Requires an experienced doctor to avoid pigmentation issues

 

Erbium Laser (Er:YAG)

Gentler on the skin compared to CO2
Advantages:
✔ Less pain
✔ Faster recovery
✔ Lower risk of pigmentation
Disadvantages:
✖ May require more than one session
✖ Not suitable for very large cases

ND:YAG Laser

Suitable for small or superficial cases, especially for darker skin.
Advantages:
✔ Safe
✔ Minimal scarring
Disadvantages:
✖ Less effective than CO2
✖ May require multiple sessions

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Surgical Treatments

Used for large, deep, or recurrent cases.

1. Traditional Surgery
   Removal of fat deposits through an incision in the area.
   Advantages:
   ✔ Permanent removal
   ✔ Suitable for very large cases
   ✔ Lower risk of recurrence
   Disadvantages:
   ✖ Small risk of scarring
   ✖ Requires a skilled surgical team

2. Radiofrequency Cautery (RF)
   Uses focused heat to remove the spot.
   Advantages:
   ✔ Quick procedure
   ✔ High precision
   ✔ Minimal scarring and quick healing
   Disadvantages:
   ✖ Risk of pigmentation for sensitive skin
   ✖ Not suitable for very deep cases

3. Plasma Pen / Fibroblast
   Uses electrical discharge to gradually burn the layers.
   Advantages:
   ✔ Non-surgical
   ✔ Less expensive than laser
   ✔ Suitable for superficial cases
   Disadvantages:
   ✖ May require more than one session
   ✖ Less effective for large cases

4. Electrocautery
   Uses a direct electric current to remove the spot.
   Advantages:
   ✔ Fast and effective
   ✔ Typically only one session needed
   Disadvantages:
   ✖ Risk of pigmentation
   ✖ Requires an experienced hand to avoid scarring

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Tips for Managing Xanthelasma and Recovery Time

Xanthelasma is not just a cosmetic concern but a sign of elevated blood lipids. Managing it requires a medical, dietary, and lifestyle approach.

Important Tips for Dealing with Xanthelasma:

• Avoid pressure or rubbing the spots: Pressing on them increases inflammation and pigmentation, making treatment harder.

• Get a full lipid profile test: To determine the cause of xanthelasma, such as high cholesterol or triglycerides.

• Control fats through medication or diet: Use cholesterol-lowering drugs, reduce fatty foods, increase fiber, and exercise regularly.

• Avoid foods that increase triglycerides: Such as fried foods, animal fats, sweets, and sodas. Replace with fish, vegetables, low-sugar fruits, olive oil, and oats.

• Do not use random creams: Exfoliating or lightening creams may cause irritation or pigmentation around the eyes.

• Use sunscreen: SPF 50 around the eyes, especially after laser or surgery, to prevent pigmentation.

• Follow up with a dermatologist: To assess the growth of the spots and choose the best treatment.

• Choose the right removal method for your condition: CO2 laser for moderate to large cases, Er:YAG for sensitive skin, surgery for huge spots, plasma or RF for light cases.

• Follow up after treatment to prevent recurrence: Especially if fats are high, with tests every 6 months.

• Maintain a healthy lifestyle: Exercise 30 minutes daily, drink enough water, sleep regularly, reduce stress, and avoid smoking.

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Recovery Time Based on Treatment Type

1. Recovery After Laser Treatment:

• CO2 Laser

  • Redness and inflammation: 3–7 days

  • Small crust: 7–10 days

  • Redness fades: 2–4 weeks

  • Final result: 4–8 weeks

• Er:YAG Laser

  • Slight redness: 2–4 days

  • Healing of the surface skin: 5–7 days

  • Final result: 3–4 weeks

• ND:YAG Laser

  • Mild redness: 1–3 days

  • Light peeling: 3–5 days

  • Full recovery: 1–2 weeks

2. Recovery After Surgery:

• Traditional Surgery

  • Swelling: 3–5 days

  • Suture removal: 5–7 days

  • Redness fades: 2–3 weeks

  • Full recovery: 4–6 weeks

• Radiofrequency (RF) Cautery

  • Redness: 2–4 days

  • Small crust: 5–7 days

  • Full recovery: 2–3 weeks

• Plasma Pen

  • Redness and brown spots: 3–7 days

  • Crusts disappear: 7–10 days

  • Full recovery: 3–4 weeks

• Electrocautery

  • Mild redness: 2–5 days

  • Fine crust: 5–7 days

  • Mark fades: 2–3 weeks