Xanthelasma: Yellow Patches on the Eyelids, Cholesterol and Removal

Xanthelasma is a soft, flat or slightly raised yellow patch on or around the eyelids, usually near the inner corner of the eye close to the nose. It is a harmless deposit of cholesterol-filled cells in the skin, but about half of people who have it also have high cholesterol, so it is a good reason to get a cholesterol blood test. It does not go away on its own; a doctor can remove it with surgery, laser, freezing, radiofrequency or a chemical peel.

Pori does not diagnose skin conditions. The selfie scans and photo diary in Pori can help you keep dated, consistent photos to show a doctor and to see whether a patch is growing or coming back after treatment.

This guide covers what xanthelasma looks like, what it says about your heart and cholesterol, the eyelid bumps it is confused with, and the pros and cons of each removal method.

What does xanthelasma look like?

Cleveland Clinic describes xanthelasma as a harmless yellow bump on or near your eyelid skin. It can be soft, chalky or semi-solid, flat or raised, and it usually sits on or by the corners of the eyelids next to the nose. A 2024 literature review in Archives of Dermatological Research describes the patches as yellow-orange spots, bumps or nodules, mainly on the upper eyelids and the inner corner of the eye.

• Color: pale yellow to yellow-orange.
• Texture: soft, chalky or semi-solid; flat or raised. It doesn't itch or hurt.
• Place: most often the inner corner of the upper lid, according to a 2018 review; the lower lids can be involved too.
• Pattern: patches often appear on both sides.

Untreated, Cleveland Clinic says a patch stays the same size or gets bigger.

Does it look different on darker skin?

The patches are yellow on every skin tone. The American Academy of Ophthalmology says xanthelasma is more common in women and those of Asian or Mediterranean descent. Skin tone matters most when choosing a treatment, because several methods can leave light or dark marks, as described below.

What causes xanthelasma, and who gets it?

Xanthelasma forms when cells loaded with fat, called foam cells, collect in the skin of the eyelid. The 2024 review links it to abnormal lipid metabolism: high blood fats, an underactive thyroid, weight gain and a fatty diet. It says women are affected about twice as often as men, usually between 35 and 55.

Cleveland Clinic lists these risk factors:

• Being female
• High cholesterol, including inherited high cholesterol
• Overweight, diabetes and high blood pressure
• Smoking
• Hypothyroidism and heavy alcohol use
• A family history of xanthelasma

It can appear at any adult age, roughly 20 to 70. It is not contagious.

Does xanthelasma mean high cholesterol?

Often, but not always. Cleveland Clinic says half of the people with xanthelasmas have high cholesterol levels; the other half have normal levels. That is why a doctor will usually order a lipid panel (a cholesterol blood test), and may also check thyroid function, blood sugar and liver function.

What about heart risk?

Xanthelasma matters even when cholesterol is normal. In the Copenhagen City Heart Study, published in the BMJ in 2011, researchers followed 12,745 adults for up to 33 years. The 4.4% who had xanthelasma at the start had a higher risk of heart attack, heart disease, severe atherosclerosis and death. The authors concluded that xanthelasma predicted that risk independently of well known cardiovascular risk factors, including blood cholesterol and triglyceride levels.

So treat a new xanthelasma as a prompt for a general heart-health check: cholesterol, blood pressure, blood sugar, weight and smoking. It does not mean you have heart disease. It means your doctor has a reason to look at your risk more closely.

Could it be inherited high cholesterol?

Sometimes. The CDC lists yellowish areas around your eyes among the physical signs of familial hypercholesterolemia (FH), an inherited cause of high cholesterol that affects about 1 in 311 people. Other signs include bumps on the knuckles, elbows or knees, a swollen Achilles tendon and a gray-white ring at the edge of the cornea. If you have xanthelasma at a young age, or close relatives had heart attacks early, ask your doctor whether FH testing makes sense. Genetic testing can confirm it, and family members can then be tested too.

Is xanthelasma the same as a xanthoma?

Xanthelasma is one kind of xanthoma, the general name for fatty deposits in the skin. The 2024 review says xanthelasma of the eyelids accounts for greater than 95% of cases of xanthoma in the skin. Xanthomas elsewhere, such as firm yellow bumps over the elbows, knees, knuckles or along tendons, point more strongly to a lipid disorder and should always be checked. The same Copenhagen study also looked at arcus, a gray-white ring at the edge of the cornea, and found it was not an important independent predictor of heart risk, unlike xanthelasma.

What should you do if you notice xanthelasma?

A calm, practical plan works best:

1. Book a routine visit with your primary care doctor. This is not an emergency.
2. Ask for a lipid panel, and mention the eyelid patches so the doctor can decide whether to check thyroid function, blood sugar and liver function too.
3. Review your heart risk: blood pressure, weight, smoking and family history. These are the factors your doctor can help you change.
4. Take a clear photo of each eyelid in good light, so you can tell later whether a patch is growing or returning after treatment.
5. Decide on removal later, once the blood work is done. There is no rush, and treating high cholesterol first may lower the chance of regrowth.

What else can look like xanthelasma?

A soft yellow plaque at the inner corner of the eyelids is usually easy for a doctor to recognize; Cleveland Clinic notes the diagnosis doesn't require tests beyond the blood work. A bump that bleeds, crusts or grows quickly needs a closer look.

How is xanthelasma removed?

Removal is optional, since the patches are harmless, and many people choose it for appearance. The AAO says xanthelasma do not go away on their own. Options include:

• Surgical excision: cutting the patch out. A 2023 systematic review in Plastic and Reconstructive Surgery Global Open found surgery more appropriate for larger and deeper lesions, sometimes combined with an eyelid lift or a skin graft.
• Laser: CO2 and Er:YAG lasers were the most studied. In the same review they produced more than 75% improvement in over 90% and 80% of patients respectively, and CO2 laser did better than Er:YAG and than trichloroacetic acid in comparison studies.
• Chemical peel: trichloroacetic acid (TCA) applied by a doctor in small amounts.
• Cryotherapy: freezing with liquid nitrogen; Cleveland Clinic says it is often tried first.
• Radiofrequency and electrosurgery: heat that destroys the deposit, suited to small, superficial patches.

Several sessions may be needed. The AAO notes possible side effects of scarring and skin color changes, and the 2023 review found dyspigmentation was the most encountered complication. If you have brown or black skin, ask the doctor how often their method leaves light or dark marks on skin like yours, and whether a test spot makes sense.

Will it come back?

Often. Cleveland Clinic says xanthelasmas often come back after removal, no matter which treatment you get. Working with your doctor to lower high cholesterol can reduce the chance. Keep photos of the area so you can see early regrowth.

Can you remove xanthelasma at home?

Please don't. Eyelid skin is thin and close to the eye. Cleveland Clinic warns that products you can buy without a prescription and use on your own could burn your skin. Acid pens and "removal creams" sold online fall into that group, and a burn this close to the eye is hard to fix.

When should you see a doctor about yellow spots on your eyelids?

Make an appointment with your primary care doctor or a dermatologist if:

• You notice a new yellow patch on your eyelids and have not had a cholesterol test recently
• You are young, or close relatives had heart disease early
• Patches are spreading, or yellow bumps also appear on your elbows, knees, knuckles or tendons
• An eyelid bump bleeds, crusts or grows quickly
• You want a patch removed, or one has come back after treatment

Removal is usually done by a dermatologist or an oculoplastic (eyelid) surgeon. You can find a dermatologist near you.