Skin Xanthomas

What Are Skin Xanthomas?

Skin xanthomas are yellowish deposits of fat-filled immune cells, called foam cells, in the skin or just beneath it. They’re benign in themselves, but they’re often a visible sign of a blood fat disorder or another condition.

Xanthomas are localized lipid deposits that are usually benign but often signal systemic disease, and they most often affect the skin and the tissue beneath it. In people with raised blood fats, lipoproteins leak through the walls of blood vessels into the skin, and tissue macrophages take up the lipid and become foam cells.^[1]

“Skin xanthomas” covers the types that sit in the skin, as opposed to tendon xanthomas, which form inside tendons. Our main xanthomas guide covers every type, xanthoma skin gives a short introduction, and tendon xanthomas covers the deeper kind.

How Can You Tell Which Type Of Skin Xanthoma You Have?

By where it is, what shape it takes and how fast it appeared. Soft plaques on the eyelids are xanthelasma; sudden crops of small bumps are eruptive; firm nodules over elbows and knees are tuberous; flat yellow lines in the palm creases are plane xanthomas.

1. Eyelids, soft and flat. Xanthelasma, usually near the inner corners.^[2]
2. Appeared within days, in crops. Eruptive xanthomas, small inflamed yellow-red bumps.^[1]
3. Firm nodules over elbows, knees or palms. Tuberous or tuberoeruptive xanthomas.^[1]
4. Flat yellow-orange lines in the palm creases. Plane (palmar) xanthomas.^[1]
5. Flat patches over wide areas with normal blood fats. Possibly a paraprotein-related plane xanthoma.^[1]
6. A firm swelling that moves with a tendon. Not a skin xanthoma but a tendon xanthoma.^[1]

This is a guide, not a diagnosis: several eyelid and skin conditions look similar, as our guide on what can be mistaken for xanthelasma shows. A doctor can confirm the type by looking, with a biopsy if needed.

Before your appointment, it helps to take clear photos in daylight and note when you first noticed the spots, whether they appeared slowly or all at once, whether they itch or hurt, and where else on your body you’ve found them. Write down any family history of high cholesterol, early heart disease or diabetes, and bring a list of your medicines. Those details, together with the location and shape of the deposits, often let a doctor narrow down the type before any blood results come back.

What Is Xanthelasma, The Eyelid Type?

Xanthelasma is soft, flat or slightly raised yellow plaques on the eyelids, usually near the inner corners. It’s the best-known skin xanthoma, and about half of people with it have a lipid disorder.

Xanthelasma palpebrarum affects about 1.1% of women and 0.3% of men, is usually seen between ages 20 and 70, and is linked with a primary or secondary lipid disorder in about half of people.^[2] In a Swiss study of 5,504 benign eyelid skin tumors, about 6% were xanthelasmas.^[1]

Unlike most skin xanthomas, xanthelasma often appears with normal blood fats, and it rarely clears once blood fats are controlled. Our main xanthelasma guide and what xanthelasma looks like cover it in full.

What Are Eruptive Xanthomas?

Crops of small, inflamed yellow-red bumps that appear within days. They’re a sign of very high triglycerides, often above 1,000 mg/dL, and they fade over weeks once triglycerides fall.

Eruptive xanthomas are acute, inflammatory bumps that appear in groups within days and fade over several weeks.^[1] They appear when triglycerides rise above 1,000 mg/dL; uncontrolled diabetes is a common driver, and triglycerides that high carry a risk of pancreatitis.^[4]

That makes eruptive xanthomas the type that most needs prompt attention. Our guides to eruptive xanthoma and xanthoma eruptive explain more.

What Are Tuberous Xanthomas?

Firm, red to yellow nodules that can merge into larger lumps, favoring the elbows, knees and palms. They usually point to an inherited lipid disorder, especially dysbetalipoproteinemia.

Tuberous and tuberoeruptive xanthomas are red, inflamed bumps that can coalesce, with a preference for sites such as the elbows and palms that can be specific for certain inherited lipid disorders.^[1] In dysbetalipoproteinemia, palmar and tuberous xanthomas become more likely when cholesterol and triglycerides rise above about 1,000 mg/dL.^[3]

Read moreHow To Cover Xanthelasma With Makeup

Because they sit over joints, tuberous xanthomas can be knocked or rubbed. Our guide to tuberous xanthoma covers them in detail.

What Are Plane And Palmar Xanthomas?

Flat yellow to orange deposits in the palm creases, finger folds and other skin folds. Palm-crease xanthomas are a hallmark of dysbetalipoproteinemia, and flat xanthomas are also seen with cholestatic liver disease.

Planar xanthomas occur in the palm creases, flexural surfaces and skin folds, and are often seen with biliary cirrhosis, now called primary biliary cholangitis. Palm-crease xanthomas can be pathognomonic for familial dysbetalipoproteinemia.^[1] In a study of 3,382 adults at a lipid clinic, palm-crease xanthomas appeared in 18.8% of people with dysbetalipoproteinemia, and about 10% of people with them had a different lipid disorder.^[6]

Once dysbetalipoproteinemia is managed, palmar crease xanthomas resolve with time.^[3] Our guides to plane xanthoma and palmar xanthoma go into detail.

What Are The Rarer Skin Xanthomas?

Flat xanthomas with normal blood fats linked to blood protein disorders, xanthoma planum over broad areas, xanthoma diabeticorum in severe diabetes, verrucous xanthomas, and the widespread lesions of xanthoma disseminatum.

• Paraprotein-related xanthomas. Flat, grouped lesions that can occur with normal blood fats.^[1] Diffuse plane xanthoma with normal lipids has been linked with monoclonal gammopathy, a blood protein disorder.^[5]
• Xanthoma planum. A planar type covering broad areas of the body.^[1]
• Xanthoma diabeticorum. Seen in severe diabetes.^[1]
• Verrucous xanthoma. A form with fat-laden cells in the connective tissue of the skin.^[1]
• Xanthoma disseminatum. A rare condition with widespread lesions; see xanthoma disseminatum.

Flat yellow patches with normal blood tests are the ones most worth investigating further, because of the possible link with a blood protein disorder. Our xanthoma definition guide lists every type.

Are Skin Xanthomas Dangerous?

The deposits themselves aren’t. They’re benign and don’t turn into cancer. What matters is the condition behind them: very high triglycerides can cause pancreatitis, inherited lipid disorders raise heart risk, and some flat xanthomas signal a blood protein disorder.

The outlook depends mainly on the underlying condition, and atheromatous deposits often coexist with xanthomas.^[1] Eruptive xanthomas signal triglycerides high enough to risk pancreatitis.^[4] Dysbetalipoproteinemia, behind many tuberous and palmar xanthomas, carries about a 10-fold higher risk of premature coronary artery disease than in the general population.^[3]

Eyelid xanthelasma is the gentlest of the group in terms of what it signals, though about half of people with it have a lipid disorder, so it’s still worth a check.^[2] Our guide to xanthoma explains each link in more depth.

How Are Skin Xanthomas Diagnosed?

Usually by looking, then by blood tests for the cause: fasting triglycerides and cholesterol, blood sugar, and liver and thyroid checks. Specific patterns lead to specialist tests, and a biopsy is used if the diagnosis is uncertain.

1. Examination. Clinical examination is usually enough to recognize a xanthoma.^[1]
2. Fasting lipids. Triglycerides, total, LDL and HDL cholesterol.^[1]
3. Blood sugar. Glucose and HbA1c as indicated.^[1]
4. Liver and thyroid tests. Part of the standard workup for xanthelasma.^[2]
5. Pattern-specific tests. Palm-crease or diffuse plane xanthomas prompt a search for their associated conditions,^[1] such as an APOE gene test for dysbetalipoproteinemia.^[3]
6. Biopsy. Used to rule out other diagnoses when needed.^[1]

Do Skin Xanthomas Go Away?

Most do, once the condition behind them is controlled. Eruptive xanthomas fade over weeks as triglycerides fall, and palm-crease xanthomas resolve with time. Eyelid xanthelasma is the exception: it rarely clears this way.

Controlling the underlying condition is the main goal, and statins lower blood fats and may shrink lesions. Small xanthomas often shrink or resolve with systemic control, and some have cleared after liver transplant or plasma exchange.^[1] Eruptive xanthomas fade over several weeks,^[1] and palmar crease xanthomas resolve with time once management of dysbetalipoproteinemia begins.^[3]

Xanthelasma behaves differently. Managing the cause protects your health but rarely clears existing eyelid plaques, which is why they’re usually removed directly (see below).

How Is Eyelid Xanthelasma Removed?

With clinic procedures such as surgery, laser or chemical peels, or at home with a removal cream made for xanthelasma. Plaques can return: recurrence is generally under 50%.

Clinic removal carries its own risks: surgical excision can make the lower lid turn outward or pull back, and freezing and chemical methods can scar and discolor the skin. Recurrence is generally under 50%, rising to around 60% after repeat procedures.^[2] Many people with small to medium eyelid plaques prefer to remove them at home, and our xanthelasma cream guide explains how that works.

If your skin xanthoma is eyelid xanthelasma, your doctor has checked the cause, and you want to deal with the plaques at home, this is the cream we make for it. It’s for eyelid xanthelasma only, not for xanthomas elsewhere on the skin.

When Should You See A Doctor About Skin Xanthomas?

Whenever you find one, and promptly if bumps appear suddenly in crops. Every type is worth a blood test, and some point to conditions that need quick attention.

• See a doctor soon for a sudden crop of small yellow-red bumps, which can mean very high triglycerides.^[4]
• Get urgent help for severe upper stomach pain, a possible sign of pancreatitis.
• Book a routine check for eyelid plaques, firm nodules over joints or yellow palm-crease lines.
• Mention family history of high cholesterol or early heart disease.
• Ask about further tests if you have flat yellow patches but normal blood fats.^[5]

What’s The Bottom Line On Skin Xanthomas?

Skin xanthomas are benign yellow deposits of fat-filled cells, and the type tells you most: eruptive ones signal very high triglycerides, tuberous and palmar ones inherited lipid disorders, and eyelid xanthelasma often occurs with normal blood fats.

See a doctor for a lipid test whatever the type, and promptly for sudden eruptions. Most body xanthomas fade once the cause is controlled. If yours is eyelid xanthelasma and you want it gone, Xanthel® is a cosmetic cream made for xanthelasma removal at home, sold by Xanthelasma.com, for the eyelid type only. You’ll find it at the foot of this page, or read more about Xanthel® xanthelasma removal cream, and browse all our xanthelasma and xanthoma guides.

Common Questions About Skin Xanthomas

Read Next

Xanthoma SkinA short introduction Eruptive XanthomaSudden crops explained Plane XanthomaThe flat type Tendon XanthomasThe deeper type XanthomasEvery type in depth XanthelasmaThe eyelid type explained