Welcome to question of the day #182

Welcome to question of the day #182

I have just examined a new patient in my practice. She is 45-years-old and denied any health problems or medication. I noticed she had yellow marking on her eyelids on both eyes. What is going on?

This sounds like xanthelasma. They are yellow deposits of cholesterol underneath the skin usually on or around the eyelids. The deposits have obvious edges. In themselves, they are not harmful or painful but may cause the person problems because of their appearance and the perceived negative effect on cosmesis.

It is rare, with an incidence of between 0.56 and 1.5% with a peak occurrence in people aged in their 40s and 50s.

Some studies suggest that there is no link between xanthelasma and the type of cholesterol that causes problems with the cardiovascular system, however, a well-conducted study in Denmark found that people with xanthelasma had a:

48% increased risk of heart attack
39% increased risk of coronary artery disease
14% increased risk of death

Another finding of the study was that xanthelasma was found to be associated with heart disease and death independent of cholesterol in the body. It was reasonable to expect that as xanthelasma are deposits of cholesterol, that any association between their presence and cardiovascular disease would have been due to raised fat levels in the body. However, people with xanthelasma were found to be at higher risk of heart attack even if total cholesterol levels in their bodies were low.

Your patient deserves to be referred to their general practitioner for a blood workup and a full cardiovascular risk profile assessment to include age, BMI, smoking, diabetes, blood pressure, and any family history of cardiovascular disease.