Xanthelasma

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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170 Xanthelasma

Instruction

Examine this patient’s eyes.

Salient features

History

• Jaundice, generalized pigmentation, itching (primary biliary cirrhosis)

• Family history of hyperlipidaemia

• History of diabetes, hypertension.

• Symptoms of hypothyroidism (p. 516)

• History of oral contraceptives.

Examination

• Xanthelasmata (flat yellow nodules or plaques) seen on eyelids and around both eyes, particularly on the inner canthus (Fig. 170.1)

• Look for the following signs:

• Corneal arcus
• Jaundice, generalized pigmentation, scratch marks (primary biliary cirrhosis)
• Tendon xanthomata
• Palmar xanthomata.

• Tell the examiner that you would like to check the following:

• Urine sugar
• Blood pressure
• Pulse and ankle jerks (hypothyroidism).
image

Fig. 170.1 Xanthelasma. Multiple, soft, yellow plaques involving the eyelid.

Remember: Blood lipids can often be normal.

Diagnosis

This patient has xanthelasmata on the eyelids (lesions) and I would like to test serum lipids to exclude an underlying lipid disorder (aetiology).

Advanced-level questions

In which conditions are xanthelasmata seen?

Those in which there is an increase in serum cholesterol (see Fig. 173.1C–E):

• Type IIb hyperlipidaemia: increased cholesterol and triglycerides

• Type IIa hyperlipidaemia: increased cholesterol only

• Type III hyperlipidaemia: equal increase in cholesterol and triglycerides.

Mention a few secondary causes of hyperlipidaemia

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