Causes Of Xanthelasma

What Causes Xanthelasma?

Xanthelasma is caused by cholesterol and other fats building up inside the skin of the eyelids. About half of people with it have a lipid disorder behind it, while the other half have normal blood fats.

The yellow cholesterol deposits on your eyelids are, quite literally, stored fat. The question is why your eyelid skin has started storing it. Research divides the answers into two groups. About 50% of people with xanthelasma have either a primary lipid disorder, meaning a blood fat problem in its own right, often inherited, or a secondary one, caused by another condition or a medicine.^[1] The other half have no lipid disorder at all, and in them the tendency seems to come from genetics and the eyelid skin itself.

Xanthelasma is the most common type of xanthoma, the family of fat deposits that can also form on tendons, joints and elsewhere; our xanthomas guide covers the whole family. If you’re more interested in which cause applies to you personally, our page on why you might have got xanthelasma walks through it, and the main xanthelasma guide covers the basics.

How Does Xanthelasma Form In The Eyelid Skin?

Fats leak from tiny blood vessels into the eyelid skin, where immune cells called macrophages swallow them. When those cells take in more fat than they can handle, they swell into “foam cells”, which cluster together into a yellow plaque.

Researchers have pieced together how the process works:^[1]

1. Blinking squeezes the small blood vessels. Every blink, the muscle around the eye compresses the capillaries in the eyelid.
2. The vessels get leakier with age. As their lining weakens, fat-carrying plasma seeps out into the surrounding eyelid tissue.
3. Immune cells take up the fat. Macrophages, which normally help clear fats away, start absorbing the cholesterol.
4. They become foam cells. When a macrophage takes in more fat than it can process, droplets build up inside it and it turns into a foamy, fat-filled cell.
5. The cells cluster into a plaque. Groups of foam cells gather in the middle layer of the skin, around small blood vessels, with some inflammation, forming the visible yellow patch.

That’s why the plaques are soft and yellow, why they sit just under the surface, and why they don’t simply wash or wear away. Our guide to how xanthelasma forms goes into each stage in more detail.

Why Does Xanthelasma Form On The Eyelids?

Because the eyelids combine thin skin, constant movement and tiny blood vessels that are squeezed thousands of times a day by blinking, which seems to make them especially prone to fats leaking in and staying.

It’s a fair question: if cholesterol is in the blood everywhere, why do the deposits so often pick the eyelids, and usually the inner corner near the nose? The answer seems to be mechanical as much as chemical. The constant compression of the eyelid capillaries with each blink, combined with vessel walls that become more permeable with age, gives fats more chance to escape into the tissue there than almost anywhere else.^[1]

This also helps explain why people with perfectly normal cholesterol can still get xanthelasma: the eyelid itself is part of the cause. And it’s why the plaques usually appear on both sides in a fairly symmetrical pattern. To check whether your marks really are xanthelasma, see what xanthelasma looks like.

Which Cholesterol Problems Cause Xanthelasma?

The lipid problems linked to xanthelasma are high LDL cholesterol, high LDL plus high triglycerides, high triglycerides alone, and low HDL, the protective “good” cholesterol.

Doctors sometimes describe blood fat problems by an older numbering system. The primary lipid disorders linked with xanthelasma are type IIa (high LDL cholesterol), type IIb (high LDL and high triglycerides), type IV (high triglycerides), and low HDL.^[1] Any of these shows up on a standard lipid panel. Here’s every known cause in one place:

For a plain-English look at what your results mean, see whether xanthelasma indicates raised cholesterol.

Is Xanthelasma Caused By Genetics?

Often, yes. Inherited high cholesterol is one well-known genetic cause, and the tendency to get xanthelasma also seems to run in families even when cholesterol is normal.

The clearest genetic cause is familial hypercholesterolemia, an inherited condition that keeps LDL cholesterol high from birth. It’s more common than many people realize, affecting between 1 in 500 and 1 in 250 people, and xanthelasma around the eyes is one of its signs, along with fatty lumps on the tendons.^[2] Each child of a parent who has it has a 50% chance of inheriting it.^[2]

Read moreTendon Xanthoma

Because inherited lipid disorders start early, xanthelasma in younger adults, and especially in children, should always prompt a doctor to look for one.^[1] If high cholesterol, xanthelasma or early heart disease runs in your family, tell your doctor; it changes which tests they’ll want. Read more in is xanthelasma genetic and our guide to tendon xanthomas.

Can Diabetes Or Thyroid Problems Cause Xanthelasma?

Yes. Both diabetes and an underactive thyroid can raise blood fats, which is why they’re among the recognized secondary causes of xanthelasma.

Diabetes and hypothyroidism are both listed among the conditions that can cause acquired high blood fats and, with them, xanthelasma.^[1] Uncontrolled type 1 or type 2 diabetes is a recognized cause of high triglycerides in particular.^[4] An underactive thyroid slows the body’s handling of cholesterol, so LDL tends to rise.

The encouraging part is that both are very manageable. Good blood sugar control and thyroid hormone replacement, when needed, can bring blood fats back toward normal, which protects your heart and may help prevent new plaques. That’s why your doctor is likely to check your blood sugar and thyroid as well as your cholesterol when you first mention xanthelasma.

Can Liver Or Kidney Problems Cause Xanthelasma?

Some can. A liver condition called primary biliary cholangitis and a kidney condition called nephrotic syndrome both raise blood fats and are recognized causes of xanthelasma, though they’re uncommon.

The liver is the body’s main processor of cholesterol, so it’s no surprise that some liver diseases affect it. In primary biliary cholangitis, the small bile ducts in the liver are gradually damaged, and an unusual fat particle called lipoprotein X builds up in the blood, which can lead to xanthelasma.^[1] Nephrotic syndrome, where the kidneys leak protein into the urine, also drives blood fats up.^[1]

Most people with xanthelasma have a healthy liver and kidneys, so there’s no need to worry. But a liver panel is a standard part of the checks for exactly this reason, and signs like itching, tiredness, yellowing of the eyes or swollen ankles are worth mentioning to your doctor.

Can Medicines Or Other Conditions Cause Xanthelasma?

Yes. Retinoids, the vitamin A-based medicines used for severe acne and some skin conditions, and estrogens can raise blood fats and are linked to xanthelasma. Sarcoidosis, an inflammatory condition, is another recognized cause.

Taking retinoid or estrogen medicines is listed among the secondary causes of xanthelasma, alongside sarcoidosis.^[1] Estrogen is found in some contraceptive pills and hormone replacement therapy, and retinoids include tablets used for severe acne.

If your plaques appeared after starting one of these, mention it to your doctor, but don’t stop any prescribed medicine on your own. Your doctor can check your blood fats and weigh up whether any change makes sense. Often the benefits of the medicine outweigh the cosmetic concern, and the plaques can be removed separately.

Does Diet Or Lifestyle Cause Xanthelasma?

They can contribute by raising cholesterol, but they’re rarely the whole story. Plenty of people with healthy diets and lifestyles still get xanthelasma, because genetics and the eyelid skin play such a large part.

A diet high in saturated fat, carrying extra weight, smoking, heavy drinking and inactivity can all push blood fats in the wrong direction, so for someone who’s already prone to xanthelasma, they may make plaques more likely. Improving them is one of the best things you can do for your heart and may help reduce new plaques.

But it’s important not to overstate it. Lifestyle doesn’t explain the half of cases with normal cholesterol, and healthier habits rarely make existing plaques go away. Think of lifestyle as something that can tip the balance, not the root cause. For practical ideas, see what foods cause xanthelasma and how to prevent xanthelasma.

What Doesn’t Cause Xanthelasma?

Makeup, eye creams, skincare products, poor hygiene and rubbing your eyes don’t cause xanthelasma, and it isn’t contagious or an infection.

A lot of people worry they’ve caused their plaques somehow, so it’s worth clearing up the common myths:

• Makeup and skincare. The fat comes from your blood, not from products on the surface of your skin.
• Hygiene. Washing more or less makes no difference; the plaques sit inside the skin.
• Infection. Xanthelasma isn’t caused by bacteria or viruses and can’t be passed to anyone else.
• Squeezing or picking. This doesn’t cause plaques, but it can damage the skin, so it’s best avoided.
• Cancer. Xanthelasma isn’t cancer and doesn’t turn into it.

Read more on whether xanthelasma can be cancerous and why you shouldn’t squeeze it.

What Does The Cause Of Xanthelasma Mean For Your Heart?

Read moreDoes Xanthelasma Come Back

Xanthelasma is a useful early warning. Whatever the cause, people with it appear to have a higher risk of heart disease, so it’s worth getting checked and looking after your heart.

When raised cholesterol is the cause, the link to heart health is obvious, because high LDL also builds up in the arteries. In familial hypercholesterolemia, the risk is especially high if it’s left untreated: in studies from before statins were common, about half of affected men had a coronary event by age 50.^[2]

Xanthelasma matters even when cholesterol is normal. A large Danish study that followed almost 13,000 people for decades found that people with xanthelasma had a higher risk of heart attack and heart disease, even after their cholesterol levels were taken into account.^[3] None of this is a reason to panic. It’s a reason to have your blood fats checked, keep up healthy habits, and see your doctor regularly. Removing the plaques is cosmetic and doesn’t change this risk either way.

Does Managing The Cause Make Xanthelasma Go Away?

Rarely. Managing the cause protects your health and may help stop new plaques, but the plaques already there are locked into the skin and usually need removing directly.

Because the cholesterol in a plaque is stored inside foam cells in the skin, bringing your blood fats down doesn’t usually draw it back out. That’s why many people find their cholesterol, blood sugar or thyroid is well controlled, yet the yellow patches stay. The sensible approach handles them as two separate jobs: your doctor manages the cause, and the visible plaques are removed in whichever way suits you.

Clinic options include surgery, laser and freezing, while an at-home cream made for xanthelasma is the least invasive, lowest-cost route for typical plaques. Our guides to the removal of xanthelasma and xanthelasma cream compare them in full.

If you’re managing the cause with your doctor and want to deal with the plaques themselves at home, this is the cream we make for xanthelasma.

What’s The Bottom Line On The Causes Of Xanthelasma?

Xanthelasma is caused by fat-filled cells collecting in the eyelid skin; about half of cases have a lipid disorder behind them, and the rest happen with normal blood fats.

See your doctor for a lipid panel and the other basic checks to find out whether a cause like inherited cholesterol, diabetes, thyroid, liver or kidney disease or a medicine is involved, and manage whatever turns up. Then deal with the plaques themselves if they bother you, because managing the cause rarely clears them. Xanthel® is a cosmetic cream made for xanthelasma removal at home, sold by Xanthelasma.com. You’ll find it at the foot of this page, or read more about Xanthel® xanthelasma removal cream and browse our other xanthelasma guides.

Common Questions About The Causes Of Xanthelasma

What Is The Main Cause Of Xanthelasma?

Cholesterol and other fats collecting in the eyelid skin, where immune cells fill with fat and cluster into plaques. About half of cases are linked to a lipid disorder; the rest happen with normal blood fats.

Does Xanthelasma Always Mean High Cholesterol?

No. About half of people with xanthelasma have a lipid disorder and half don’t, so a blood test is the only way to know.

Is Xanthelasma Hereditary?

It can be. Familial hypercholesterolemia is an inherited cause, and the tendency to get xanthelasma also seems to run in families even with normal cholesterol.

Can Diabetes Cause Xanthelasma?

Yes. Diabetes can raise blood fats, especially triglycerides, and it’s one of the recognized secondary causes of xanthelasma, along with an underactive thyroid.

Do Liver Problems Cause Xanthelasma?

Some can. Primary biliary cholangitis is a recognized cause, but most people with xanthelasma have a healthy liver, and a liver panel can check.

Does Diet Cause Xanthelasma?

Read moreXanthoma Skin

Diet can contribute by raising cholesterol, but it’s rarely the whole story. Healthy eating helps your heart and may reduce new plaques, but usually won’t clear existing ones.

Does Makeup Or Skincare Cause Xanthelasma?

No. The fat in the plaques comes from the blood, not from products on the skin, so makeup, eye creams and skincare don’t cause xanthelasma.

Will Managing The Cause Make Xanthelasma Go Away?

Rarely. Managing the cause protects your health and may stop new plaques, but existing plaques usually need removing directly.

Read Next

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