The Routes In: How The Plaques Build Up Step By Step, The Five Ways People End Up With Them, And What Doesn’t Cause Them
You get xanthelasma when fats leak from tiny eyelid blood vessels into the skin and are swallowed by immune cells, which turn into foam cells and collect as yellow plaques. About half of people who get it have a blood fat disorder; in the rest, age, sex, hormones and local eyelid factors seem to tip the balance. You can’t catch it from anyone.
Xanthelasma develops over months as fats seep from eyelid blood vessels and fat-filled immune cells (foam cells) gather in the skin. People usually get it through an inherited or acquired blood fat disorder, conditions such as diabetes or an underactive thyroid, certain medicines, or simply age and local eyelid factors. It isn’t contagious, and it’s rarely anyone’s fault.
Key Takeaways
- Xanthelasma forms when foam cells collect in the eyelid skin.
- Blinking and age make eyelid vessels leakier, which lets fats seep in.
- About half of people who get it have a blood fat disorder.
- Diabetes, thyroid, liver and kidney conditions and some medicines raise the odds.
- It’s most common in women aged 35 to 55.
- You can’t catch it, and it’s rarely caused by anything you did.
On This Page 17 sections
How Do You Get Xanthelasma?
You get xanthelasma when fats from your blood leak into your eyelid skin and immune cells swallow them, becoming foam cells that collect as soft yellow plaques. A blood fat disorder drives this in about half of people.
Xanthelasma palpebrarum is the most common form of xanthoma, a deposit of lipid-laden immune cells in the skin.[1] It usually appears near the inner corners of the eyelids, often on both sides and more often on the upper lid.[2] It builds slowly, so most people notice a faint yellow patch that becomes more defined over months.
This page focuses on how people come to have it. For the full medical explanation of each cause, see the causes of xanthelasma; for a personal checklist, why have I got xanthelasma. Our main xanthelasma guide covers the condition itself.
How Does Xanthelasma Build Up, Step By Step?
Fats circulate in the blood, seep through leaky eyelid capillaries, get swallowed by macrophages, turn those cells into foam cells, and the foam cells gather in the deeper skin until you can see them.
- Fats in the blood. Cholesterol and other lipids travel in particles such as LDL.
- Leaky vessels. Blinking repeatedly squeezes eyelid capillaries, and with age they become leakier.[1]
- Fats enter the skin. Lipids seep into the tissue around the vessels.
- Immune cells respond. Macrophages take up the fat to clear it.
- Foam cells form. Overloaded macrophages become foam cells, with some inflammation.[1]
- Plaques appear. The foam cells gather in the reticular dermis and show through as yellow patches.
Our guide on how xanthelasma forms goes deeper into each step.
How Long Does It Take To Get Xanthelasma?
Usually months. Most people first notice a faint yellow tint that doesn’t wash off, which becomes a defined plaque over months and may slowly grow or be joined by others over years.
Xanthelasma tends to stay the same or slowly enlarge once it has formed, rather than fading.[1] A spot that appears within days, or changes quickly, isn’t typical and should be checked by a doctor. Because plaques more than about 1 mm deep come back more often after removal,[1] noticing them early gives you more options. Our guides on how fast xanthelasma grows and how long xanthelasma can last explain the timeline.
Why Do You Get Xanthelasma On The Eyelids?
Because the eyelid is a uniquely busy, thin-skinned spot: blinking constantly compresses its small blood vessels, and those vessels become leakier with age, so fats escape into the skin there more than elsewhere.
That mechanical stress is the leading explanation for why xanthelasma favors the eyelids.[1] It also explains why plaques often appear on both sides, in matching positions near the inner corners, and why some people with normal blood fats still get them. Our guide on why xanthelasma occurs explains this in more detail.
What Are The Main Ways People Get Xanthelasma?
Five routes stand out: an inherited blood fat disorder; another condition that raises blood fats; certain medicines; age, sex and hormones; and, in people with normal blood fats, local eyelid and immune factors. Many people have more than one.
- Inherited blood fats. Such as familial hypercholesterolemia or low HDL.
- Other conditions. Diabetes, an underactive thyroid, liver or kidney disease.
- Medicines. Retinoids and estrogens.
- Age, sex and hormones. Most common in women in midlife.
- Normal blood fats. Local and immune factors in the eyelid.
The sections below take each route in turn.
Can You Get Xanthelasma From Inherited High Cholesterol?
Yes. Inherited lipid disorders, such as familial hypercholesterolemia and types IIa, IIb and IV hyperlipidemia, are among the primary causes. Familial hypercholesterolemia affects about 1 in 250 to 1 in 500 people and passes to each child with a 50% chance.
Primary causes of xanthelasma include types IIa, IIb and IV hyperlipidemia and low HDL.[1] Familial hypercholesterolemia causes very high LDL from birth, and its signs include xanthelasma and lumps on the tendons; statins are the first-line medicine.[3] When xanthelasma appears in young people, an inherited disorder is more likely.[1] Our guide on whether xanthelasma is genetic covers the family side.
Can Other Health Conditions Give You Xanthelasma?
Yes. Diabetes, an underactive thyroid, primary biliary cholangitis (a liver condition), nephrotic syndrome (a kidney condition) and sarcoidosis are recognized secondary causes, mostly because they raise or disturb blood fats.
All five are listed as secondary causes in StatPearls.[1] People with xanthelasma also tend to have higher total cholesterol, LDL and apolipoprotein B and lower apolipoprotein A1 than people without it, according to a meta-analysis of 854 patients.[4] Getting the underlying condition under control can help prevent new plaques. Our guide on what xanthelasma indicates explains the tests.
Can Medicines Give You Xanthelasma?
Some can. Retinoid medicines and estrogens are listed as secondary causes because they can raise blood fats. Never stop a prescribed medicine without talking to your doctor.
Retinoids include some acne and skin medicines; estrogens include some contraceptives and hormone replacement therapy.[1] If plaques appeared after you started one, mention it at your appointment. Often the medicine can continue with monitoring of your blood fats.
Does Age, Sex Or Hormones Make You More Likely To Get Xanthelasma?
Yes. Xanthelasma affects about 1.1% of women and 0.3% of men, usually between 20 and 70 and most often between 35 and 55. Hormonal factors may help explain why women get it more.
Prevalence figures come from StatPearls.[1] In a study of 42 patients, 85.7% were women and the average age was about 47, and the authors listed hormonal factors among the possible explanations.[5] The age link also fits the mechanism, since eyelid vessels become leakier over time. Our guide on whether xanthelasma is common covers who gets it.
How Do You Get Xanthelasma With Normal Cholesterol?
Many people do. Between 25% and 70% have normal blood fats when xanthelasma is found. Low HDL, local eyelid factors, hormones and how immune cells behave seem to matter more than total cholesterol in these people.
That range comes from EyeWiki.[2] In the 42-patient study, 54.8% had normal cholesterol, but HDL was markedly lower in people with xanthelasma than without (a median of 36.2 versus 50.5 mg/dL), and 26.2% had familial hyperlipidemia.[5] So a normal total cholesterol doesn’t rule out a lipid pattern worth knowing about; ask about HDL and triglycerides too. Our guide on whether xanthelasma indicates raised cholesterol explains more.
How You Get Xanthelasma: The Routes Compared
| Route | Examples | Who It Affects | What To Ask For |
|---|---|---|---|
| Inherited blood fats | Familial hypercholesterolemia, low HDL | Often appears young; runs in families | Full lipid profile; family testing |
| Other conditions | Diabetes, underactive thyroid, liver or kidney disease | People with those conditions | Blood sugar, thyroid, liver and kidney tests |
| Medicines | Retinoids, estrogens | People taking them | Lipid check and medicine review |
| Age, sex, hormones | Midlife, female, around menopause | Most common group | Lipid check |
| Normal blood fats | Local eyelid and immune factors | 25% to 70% of people at diagnosis | HDL and triglycerides; heart check |
| Any route, plaques present | Plaques rarely fade by themselves | Everyone with xanthelasma | Removal options, clinic or at home |
What Doesn’t Give You Xanthelasma?
You can’t catch it from another person, and it isn’t caused by poor hygiene. It’s a collection of fat-filled immune cells in your own skin, not an infection, and it’s rarely the result of anything you did wrong.
Because xanthelasma forms from your own blood fats and immune cells,[1] it can’t spread by touch, towels or sharing makeup. Diet affects blood fats and so can play a part where cholesterol is raised, but many people with healthy habits still get it, as the normal-cholesterol figures show. Our guide on what foods cause xanthelasma separates evidence from myth.
Can You Avoid Getting Xanthelasma?
Not always, because age, sex and inherited traits can’t be changed. But keeping blood fats, blood sugar and thyroid under control, eating well, staying active and not smoking lowers the chance of plaques forming or new ones appearing.
- Know your numbers. Regular lipid checks, especially with a family history.
- Manage conditions. Diabetes and thyroid problems well controlled.
- Eat for your heart. More vegetables, whole grains and fish; less saturated fat.
- Stay active and keep a healthy weight.
- Don’t smoke.
Our guide on how to prevent xanthelasma covers prevention in depth.
What Does Getting Xanthelasma Mean For Your Heart?
It’s a reason for a heart health check. Xanthelasma has been linked with a higher risk of heart attack and heart disease, even in people whose cholesterol is normal.
A study that followed almost 13,000 people from the general population for decades found that those with xanthelasma had a higher risk of heart attack and heart disease, independent of cholesterol.[6] The meta-analysis of 854 patients also found thicker carotid artery walls and a higher risk of atherosclerosis in people with xanthelasma.[4] Most people with xanthelasma won’t have a heart attack, but knowing the link means you can act early.
What Should You Do Once You’ve Got Xanthelasma?
See your doctor for blood tests and manage any cause they find, then decide whether to cover or remove the plaques, which rarely fade by themselves.
The usual checks are a fasting lipid profile, liver panel, thyroid tests and fasting glucose.[1] For the plaques, clinic options include laser, surgery and peels, and small to medium plaques can also be removed at home. Our guides on how you get rid of xanthelasma, xanthelasma cream and how to cover xanthelasma explain the options.
If your doctor has checked the cause and you want to remove the plaques at home, this is the cream we make for xanthelasma.
What’s The Bottom Line On How You Get Xanthelasma?
You get xanthelasma when fats leak into eyelid skin and foam cells collect there, usually through a blood fat disorder, another health condition, certain medicines, or age and local factors. It isn’t contagious and rarely anyone’s fault, but it’s worth a doctor’s check.
Xanthel® is a cosmetic cream made for xanthelasma removal at home, sold by Xanthelasma.com. You’ll find it in the box above, or read more about Xanthel® xanthelasma removal cream, and browse all our xanthelasma guides.
Common Questions About How You Get Xanthelasma
How Do You Get Xanthelasma?
Fats leak from tiny eyelid blood vessels into the skin, immune cells swallow them and become foam cells, and the foam cells collect as yellow plaques.
Do You Get Xanthelasma From High Cholesterol?
Often, but not always. About half of people with xanthelasma have a blood fat disorder; the rest have normal levels.
Can You Get Xanthelasma With Normal Cholesterol?
Yes. Between 25% and 70% of people have normal blood fats when it’s found; low HDL, local eyelid factors and hormones may matter more.
Can You Catch Xanthelasma From Someone Else?
No. It forms from your own blood fats and immune cells in your skin, so it isn’t contagious.
Who Is Most Likely To Get Xanthelasma?
Women aged 35 to 55 most often, and people with inherited high cholesterol, diabetes, an underactive thyroid or liver disease.
Can Medicines Give You Xanthelasma?
Some can. Retinoids and estrogens are listed as secondary causes; don’t stop a prescribed medicine without your doctor’s advice.
Can You Stop Yourself Getting Xanthelasma?
Not always, but controlling blood fats, blood sugar and thyroid, eating well, staying active and not smoking lowers the odds.
What Should I Do Once I’ve Got Xanthelasma?
See your doctor for blood tests and manage any cause, then decide whether to cover or remove the plaques.
Sources
- Blair K. Xanthelasma Palpebrarum. StatPearls, National Library of Medicine (NCBI Bookshelf), updated 2026.
- Patadia A, Rana HS, Stewart K, Yen MT, Lee H. Xanthelasma. EyeWiki, American Academy of Ophthalmology, reviewed September 2026.
- Ison HE, Clarke SL, Knowles JW. Familial Hypercholesterolemia. GeneReviews, National Library of Medicine (NCBI Bookshelf), revised 2025.
- Chang HC, Sung CW, Lin MH. Serum lipids and risk of atherosclerosis in xanthelasma palpebrarum: a systematic review and meta-analysis. Journal of the American Academy of Dermatology, 2020;82(3):596-605.
- Kavoussi H, Ebrahimi A, Rezaei M, Ramezani M, Najafi B, Kavoussi R. Serum lipid profile and clinical characteristics of patients with xanthelasma palpebrarum. Anais Brasileiros de Dermatologia, 2016;91(4):468-471.
- Christoffersen M, Frikke-Schmidt R, Schnohr P, Jensen GB, Nordestgaard BG, Tybjaerg-Hansen A. Xanthelasmata, arcus corneae, and ischaemic vascular disease and death in general population: prospective cohort study. BMJ, 2011.
