What Does Xanthelasma Look Like

What Does Xanthelasma Look Like?

Xanthelasma looks like soft, yellowish patches or plaques on the eyelids, with fairly well-defined edges. They usually sit near the inner corner of the eye, close to the nose, and often appear on both sides in a similar place.

The patches are made of fat-filled immune cells in the eyelid skin, which is why they look the way they do.^[1] Reviews describe them as ranging from flat and soft to nodular and semi-solid,^[2] and from a single small spot to plaques that cover much of the eyelids. The surface is usually smooth, and there’s no redness, crusting or scaling.

Xanthelasma doesn’t cause symptoms. It doesn’t hurt, itch or affect your vision, and it never limits how the eyelid works.^[2] So the way it looks is really the only sign you’ll have. Below we go through each feature in turn. For the condition as a whole, see our main guide to xanthelasma, and for everything you might notice, xanthelasma symptoms.

What Color Is Xanthelasma?

Yellow to yellow-orange, sometimes described as straw-colored or creamy. The color is the single biggest clue, because most other eyelid bumps are white, skin-colored or red.

The shade varies a little from person to person. Thin, early patches can be pale and easy to miss, especially in dim light, while thicker plaques tend to be a deeper, more obvious yellow or orange. The color is usually even across the patch, without darker spots or a central dot.

Some people describe their patches as white or cream rather than yellow. Pure white, firm dots are more likely to be milia, a common lookalike; our guide on whether xanthelasma can be white explains the difference. Good natural daylight and a mirror are the best way to judge the color.

What Shape And Texture Is Xanthelasma?

It ranges from flat, soft patches level with the skin to slightly raised plaques and, less often, firmer bumps or nodules. Most are soft, smooth and oval or irregular in outline, with fairly clear edges.

Doctors describe four broad forms:^[2]

• Flat (macular). Level with the skin, soft and thin; often the earliest stage.
• Plaques. Broader soft patches, flat or very slightly raised.
• Papules. Small, clearly raised yellow bumps.
• Nodules. Thicker, firmer lumps that can feel semi-solid.

Plaques often follow the natural curve of the eyelid, and two nearby patches can join into one. When you press gently, xanthelasma feels soft rather than hard; a hard, fixed lump is less typical. Our guide on whether xanthelasma can be flat covers the shapes in more detail.

Where On The Eyelids Does Xanthelasma Appear?

Most often on the upper eyelid near the inner corner of the eye, close to the nose. It can spread into the inner corner itself and onto the lower lids, and it usually appears on both eyes.

The inner corner of the upper lid is the classic spot, and plaques tend to be symmetrical, appearing in a similar position on both sides.^[2] In one case-control study of 42 people, upper-lid involvement was the most common pattern, and about a quarter had plaques on both upper lids.^[3]

Less often, xanthelasma starts on the lower lids or on the outer part of the eyelid. Plaques under the eyes can be harder to tell apart from other bumps, because syringomas also favor the lower lids. Our guides to xanthelasma around the eyes, xanthelasma on eyelids and xanthelasma under the eyes look at each area.

How Big Is Xanthelasma, And How Much Of The Eyelid Can It Cover?

Anything from a pinhead-sized spot to plaques well over a centimeter long. Doctors grade it from I to IV by how much of the eyelids it covers, from the upper lids only to widespread plaques on all four lids.

The grading system describes the spread:^[2]

1. Grade I. Upper eyelids only.
2. Grade II. Extending into the inner corner of the eye.
3. Grade III. The inner side of both upper and lower eyelids.
4. Grade IV. Widespread on the inner and outer sides of the upper and lower lids.

Read moreHow Does Xanthelasma Work

Most people have the smaller grades. In a surgical series of 95 patients, 35% were grade I, 35% grade II, 25% grade III and just 5% grade IV.^[4] In the 42-patient study, more than half the plaques were classed as mild.^[3] Doctors also note how tall a plaque is, since raised plaques over 5 mm are handled differently when it comes to removal.^[2]

How Does Xanthelasma Change Over Time?

It usually starts as a small, faint, flat patch and slowly grows, thickens and spreads over months or years. New patches can appear next to it or on the other eyelid. It rarely fades on its own.

A typical progression looks like this:

1. Early. A faint, flat, pale yellow mark, easy to mistake for a shadow or skin tone change.
2. Established. A clearer yellow patch with defined edges, sometimes slightly raised.
3. Spreading. Nearby patches appear and may merge; the other eye is often involved.
4. Long-standing. Some plaques become thicker and firmer and can reach deeper into the skin.

Not everyone follows every stage, and some plaques stay small for years. In the 42-patient study, 69% had noticed their plaques for less than a year when they were seen.^[3] Doctors draw a line at about a year, because older, harder plaques are more likely to have reached deeper into the skin.^[2] Our guides on how fast xanthelasma grows, whether xanthelasma can get bigger and whether xanthelasma spreads go further.

What Does Xanthelasma Look Like On Different Skin Tones?

On lighter skin it tends to stand out as clearly yellow. On medium and darker skin it can look more yellow-orange, tan or muted, and the contrast with the surrounding skin may be less obvious, though the texture and position are the same.

The fat-filled cells are the same in everyone, but how they show through depends on the surrounding skin. On deeper skin tones, xanthelasma can look like a slightly lighter, yellowish or tan patch rather than a bright yellow one, and early flat patches can be especially easy to miss.

That’s why the other features matter: the classic inner-corner position, the soft texture, the defined edges and the tendency to appear on both sides. If you’re unsure, a doctor or dermatologist can usually tell by looking.^[1] It’s also worth knowing that some removal methods can leave lighter or darker patches, which can be more noticeable on darker skin.

Why Does Xanthelasma Look Yellow?

Because the patches are made of fat-filled immune cells sitting under very thin eyelid skin. You’re seeing the stored fat, including cholesterol, through the skin.

Fat leaks from the tiny blood vessels of the eyelid, which blinking squeezes and which become leakier with age. Immune cells called macrophages swallow it and become “foam cells”, clustering around the vessels in the deeper layer of the skin.^[1] Fat is naturally yellow, and eyelid skin is the thinnest on the body, so even a thin layer shows through as a yellow patch. Thicker deposits look deeper in color and more raised.

The color doesn’t tell you whether your cholesterol is high. About half of people with xanthelasma have a blood fat disorder, and about half have normal results,^[1] so a blood test is the only way to know. Our guide on whether xanthelasma indicates raised cholesterol explains more.

How Do You Tell Xanthelasma From Similar-Looking Bumps?

Check the color, the feel and the position. Xanthelasma is yellow, soft and usually at the inner corners on both sides. Milia are pure white and firm, syringomas are skin-colored clusters on the lower lids, styes are red and tender, and skin tags hang from a stalk.

The eye area has several common bumps, and the table below compares them side by side. A few quick tests help:

• Is it yellow? Yellow points strongly to xanthelasma; white, skin-colored or red points elsewhere.
• Is it soft? Xanthelasma is soft; milia and syringomas feel firm.
• Is it painless? Xanthelasma never hurts; a tender, swollen lump suggests a stye or infection.
• Is it on both sides? Symmetry at the inner corners is typical of xanthelasma.

A doctor can usually confirm xanthelasma by looking, and a small biopsy settles it if there’s any doubt.^[1] Our guides to what can look like xanthelasma and what can be mistaken for xanthelasma cover each lookalike in more depth.

What Signs Suggest It Might Not Be Xanthelasma?

See a doctor promptly if a yellow patch is hard, ulcerated, bleeding or growing fast, if it spreads well beyond the eyelids, or if you also have yellow lumps on your tendons, elbows or knees.

Yellow lumps elsewhere on the body can be other types of xanthoma, which are more often linked to a blood fat disorder; our guide to xanthomas explains them. Xanthelasma appearing at a young age is also worth a closer look, because an inherited cholesterol condition is more likely.^[1]

What Should You Do Once You’ve Spotted Xanthelasma?

See your doctor once to confirm it and have a blood test for cholesterol, thyroid, liver and blood sugar. Then, if the patches bother you, choose how to remove them.

Read moreXanthomatosis

The usual check is a fasting lipid profile, liver panel, thyroid tests and a blood sugar test.^[1] Don’t squeeze or pick the patches: the fat is locked inside cells in the skin, so nothing will come out, and you risk infection and scarring. Makeup can cover flat patches in the meantime; see hiding xanthelasma with makeup.

When it comes to removal, the plaque’s look matters: soft, flat, recent plaques suit more methods than thick, hard, long-standing ones.^[2] Our guides on what to do about xanthelasma and the removal of xanthelasma compare the options, and xanthelasma cream covers the at-home route.

If what you’re seeing matches xanthelasma and your doctor has checked your blood, this is the cream we make for removing it at home.

What Does Xanthelasma Look Like? The Bottom Line

Xanthelasma looks like soft, yellow to yellow-orange patches with clear edges, usually at the inner corners of the upper eyelids on both sides. It can be flat or raised, small or large, and tends to grow slowly. The yellow color sets it apart from most lookalikes.

If that matches what you’re seeing, have one check-up and a blood test, then decide whether to remove it. 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 all our xanthelasma guides.

Common Questions About What Xanthelasma Looks Like

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