What Is Xanthelasma Caused By

What Is Xanthelasma Caused By?

Xanthelasma is caused by fats from the blood leaking into the eyelid skin and being swallowed by immune cells, which swell into fat-filled foam cells and cluster into yellow plaques. The underlying reason differs from person to person: a blood fat disorder in about half, another health condition in some, and no measurable cause in the rest.

It helps to separate two questions. “What are the plaques made of?” has one answer for everyone: foam cells packed with fat, sitting in the deeper layer of the eyelid skin.^[1] “Why did they form in me?” has several possible answers, and that’s what most people mean when they ask what causes xanthelasma.

About 50% of people with xanthelasma have a primary or secondary lipid disorder.^[1] Primary means the blood fat problem is the main issue, often inherited. Secondary means another condition, such as diabetes or an underactive thyroid, is pushing blood fats up. The other half have normal blood tests, and local eyelid factors are thought to be enough on their own.

This page ranks each cause by how strong the evidence is. For other angles, our main guide to the causes of xanthelasma gives the full medical explanation, xanthelasma: what causes it turns each cause into a plan of action, and why have I got xanthelasma helps you work out which cause is yours.

How Do The Plaques Actually Form?

Blinking squeezes the tiny blood vessels in the eyelid, and these vessels become leakier with age. Fat-carrying particles escape into the skin, immune cells called macrophages swallow them, and once overloaded they become foam cells that gather around the vessels.

Every cause on this page feeds into the same local process.^[1] If there’s more fat in the blood, more can leak out. If the vessels are leakier, even normal amounts can escape. Either way, the macrophages that clean up the escaped fat become overloaded, turn into foam cells, and collect in the reticular dermis, the deeper layer of the skin, along with some inflammation.^[1]

This is why the eyelids are such a common spot. Their skin is the thinnest on the body, they move constantly, and even a thin layer of fat-filled cells shows through as yellow. It also explains why the plaques don’t clear when the cause is fixed: the fat is locked inside living cells, not floating free. Our guides to how xanthelasma forms and why xanthelasma occurs go deeper.

Is Xanthelasma Caused By High Cholesterol?

Often, and this is the cause with the strongest evidence. People with xanthelasma have higher total cholesterol, LDL and apolipoprotein B on average, and lower HDL. But it isn’t universal: about half of people with xanthelasma have normal blood fats.

The best summary of the evidence is a meta-analysis that pooled 15 case-control studies covering 854 people with xanthelasma. Compared with people without it, they had significantly higher total cholesterol, LDL cholesterol and apolipoprotein B (the protein that carries LDL), and lower apolipoprotein A1, the main protein in “good” HDL.^[2]

Individual studies show how mixed the picture is. In one case-control study of 42 people with xanthelasma, 45.2% had high cholesterol and 54.8% had normal cholesterol. The clearest difference from matched controls was low HDL: a median of 36.2 against 50.5 mg/dL.^[3] The blood fat patterns most often seen include raised LDL, mixed raised cholesterol and triglycerides, and low HDL.^[1]

So cholesterol deposits on the eyelids are a good reason for a lipid test, but not proof of high cholesterol. Our guide on whether xanthelasma indicates raised cholesterol explains what results might show.

Can Xanthelasma Be Caused By Your Genes?

Yes. Inherited cholesterol disorders are a well-established cause, especially familial hypercholesterolemia, which affects about 1 in 250 to 1 in 500 people and passes to each child with a 50% chance. Doctors look for it particularly when xanthelasma appears at a young age.

Familial hypercholesterolemia (FH) keeps LDL cholesterol high from birth because the body can’t clear it properly. It’s inherited in a dominant way, so each child of an affected parent has a 50% chance of having it. People with FH can develop xanthelasma as well as tendon xanthomas, firm fatty thickenings on the Achilles tendons, elbows, hands, knees and feet.^[5]

Finding FH matters far more than the eyelids. Without medical care, about half of men with FH had a coronary event by 50 and about 30% of women by 60, and cholesterol-lowering statins are the first-line approach.^[5] That’s why doctors consider an inherited lipid disorder whenever xanthelasma appears in younger people.^[1] In the 42-patient study, 26.2% had a family history of high blood fats.^[3]

Read moreWhy I Have Xanthelasma

Our guide on whether xanthelasma is genetic covers the family side, and tendon xanthomata explains the tendon lumps.

Can Diabetes Or Metabolic Syndrome Cause Xanthelasma?

They can contribute. Diabetes is a recognized secondary cause, and in one study about four in ten people with xanthelasma had metabolic syndrome, a cluster of raised waist size, blood pressure, blood sugar and triglycerides.

Diabetes affects the way the body handles fat, which is why a fasting glucose test, and HbA1c for people with diabetes, is part of the standard check for xanthelasma.^[1] A 2024 study of 55 people with xanthelasma looked more widely at metabolic syndrome. It found the syndrome in 41.8% of them. Those with it had higher rates of raised blood sugar (47.8% against 18.8%), raised triglycerides (56.5% against 25%) and high blood pressure (82.6% against 9.4%) than those without.^[6]

The authors also found that people aged 41 or over who’d had a plaque for more than a year were especially likely to have metabolic syndrome, and they saw xanthelasma as a chance to catch it early.^[6] Managing blood sugar, weight and blood pressure is good for your heart and may help limit new plaques, but it doesn’t usually clear the ones already there.

Can Thyroid Problems Cause Xanthelasma?

Yes. An underactive thyroid (hypothyroidism) is a recognized secondary cause, because a slow thyroid raises cholesterol. A simple blood test checks for it, and it’s part of the standard workup.

Hypothyroidism is listed among the secondary causes of xanthelasma, alongside diabetes and liver and kidney conditions, and thyroid function tests are part of the recommended check.^[1] It’s worth testing for because its symptoms, such as tiredness, feeling cold, weight gain and dry skin, are easy to put down to other things.

You may read that thyroid hormone replacement makes xanthelasma shrink. We haven’t found good evidence for that. Getting the thyroid back in balance is important for your health and your cholesterol, and it may help limit new plaques, but existing plaques generally need removing separately.

Can Liver Or Kidney Conditions Cause Xanthelasma?

Some can. The best-known liver cause is primary biliary cholangitis, which produces an unusual fat particle called lipoprotein X. The kidney condition nephrotic syndrome can also raise blood fats enough to cause xanthelasma. Both are uncommon causes.

Primary biliary cholangitis, once called primary biliary cirrhosis, slowly damages the small bile ducts in the liver. As bile backs up, an abnormal fat particle called lipoprotein X builds up in the blood, and xanthelasma can follow.^[1] Nephrotic syndrome, a kidney condition that leaks protein into the urine, pushes cholesterol up and is also listed as a secondary cause.^[1]

These are rare compared with ordinary blood fat disorders, and most people with xanthelasma have healthy livers and kidneys. A liver panel is part of the standard check;^[1] kidney tests are usually added only if there are other signs, such as swelling or protein in the urine. If you’ve read that other liver conditions cause xanthelasma, ask your doctor, but the recognized link is with primary biliary cholangitis.

Can Medicines Or Other Conditions Cause Xanthelasma?

Yes, occasionally. Taking retinoid or estrogen medicines can raise blood fats, and the inflammatory condition sarcoidosis has also been linked with xanthelasma.

Retinoids, used for severe acne and some other skin conditions, and estrogens, found in some contraceptive pills and hormone replacement, can push blood fats up in some people. Both are listed as secondary causes of xanthelasma.^[1] If your plaques appeared after starting one of these, mention it to your doctor; never stop a prescribed medicine without advice.

Sarcoidosis, an inflammatory condition that can affect many organs, has also been reported alongside xanthelasma.^[1] It’s rare, but it’s another reason the cause is worth a proper look rather than a guess.

What Causes Xanthelasma When Every Test Is Normal?

Local factors in the eyelid itself. With age, eyelid vessels become leakier, and blinking keeps squeezing them, so even normal amounts of blood fat can slowly escape into the skin. Researchers also suspect hormonal and immune-cell factors.

About half of people with xanthelasma have normal blood fats,^[1] which surprises many people. In the 42-patient study, the rates of high cholesterol and high triglycerides weren’t significantly different from matched controls, and the authors concluded that local, hormonal or macrophage-related factors probably contribute.^[3]

The pooled analysis also found higher apolipoprotein B in people with xanthelasma,^[2] a measure that standard cholesterol tests don’t always report, so a “normal” result may not tell the whole story. If your tests are normal, that’s good news for your health, and the plaques are simply a cosmetic matter you can deal with if you’d like to. Xanthelasma is more common in women, and most people notice it between 35 and 55.^[1]

Can Diet, Weight, Smoking Or Alcohol Cause Xanthelasma?

Read moreWhy Xanthelasma Occur

Indirectly at most. These habits can worsen blood fats, blood sugar and waist size, which are linked with xanthelasma, but no single food or habit has been shown to cause it directly. Genes and health conditions usually play a bigger part.

The evidence links xanthelasma with raised LDL and low HDL,^[2] and with metabolic syndrome, where a larger waist, higher blood pressure and raised triglycerides cluster together.^[6] Anything that pushes those the wrong way, such as a diet high in saturated fat, carrying extra weight, inactivity, smoking or heavy drinking, can add to the risk indirectly. Here’s how the evidence breaks down:

Healthy habits protect your heart and may help limit new plaques. Our experience is that they rarely shrink existing ones noticeably. See what foods cause xanthelasma and how to prevent xanthelasma for the practical side.

What Does The Cause Of Xanthelasma Mean For Your Heart?

Xanthelasma has been linked with a higher risk of heart attack and heart disease, even after allowing for cholesterol. Whatever your cause turns out to be, it’s a good prompt to check your heart health.

A 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, independent of their cholesterol levels.^[4] The pooled analysis of 15 studies also found thicker carotid artery walls in people with xanthelasma, an early sign of hardening of the arteries.^[2]

These are patterns across large groups, not a prediction for you. But they’re why xanthelasma deserves one check-up covering blood pressure, cholesterol, blood sugar and family history. Our guides on whether xanthelasma is dangerous and what xanthelasma indicates put the risk in proportion.

How Do You Find Out What Caused Your Xanthelasma?

One visit to your family doctor and one set of blood tests usually does it: a fasting lipid profile, liver panel, thyroid tests and a blood sugar test, plus questions about your family history and medicines.

1. Fasting lipid profile. Total cholesterol, LDL, HDL and triglycerides.^[1]
2. Liver panel. To look for primary biliary cholangitis and other liver problems.^[1]
3. Thyroid function tests. To rule out an underactive thyroid.^[1]
4. Fasting glucose, and HbA1c if you have diabetes. To check blood sugar.^[1]
5. Blood pressure and waist measurement. To look for metabolic syndrome.^[6]
6. Family history and a medicine review. To spot inherited high cholesterol and medicines that raise blood fats.

Our guide on which doctor to see about xanthelasma explains when a specialist comes in.

How Do You Get Rid Of Xanthelasma, Whatever The Cause?

Managing the cause protects your health, but it rarely clears the plaques you already have. Those need removing separately, at a clinic or at home, and removal works the same way whatever caused them.

Xanthelasma rarely fades by itself, as our guide on whether xanthelasma can go away on its own explains. So most people follow two tracks: manage the cause with their doctor, and deal with the plaques themselves. Clinic options include laser, surgery, freezing and chemical peels. They work, but surgery can pull the lower lid out of position, and freezing or chemical methods can scar or discolor the skin.^[1]

Recurrence after removal is generally under 50%, and deeper plaques come back more often.^[1] Keeping the cause under control gives you the best chance of fewer new plaques; see does xanthelasma come back. Our guides to the removal of xanthelasma and how to get rid of xanthelasma compare every option.

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

For more on the at-home route, see xanthelasma cream.

What’s The Bottom Line On What Xanthelasma Is Caused By?

Xanthelasma is caused by fat collecting in immune cells in the eyelid skin. Blood fat disorders have the strongest evidence, followed by inherited high cholesterol and metabolic problems, with thyroid, liver, kidney and medicine causes less common. Half of people have normal tests.

Read moreHow Does Xanthelasma Form

Have one check-up to find your cause, because that’s about your heart. Then, if the plaques bother you, remove them, because fixing the cause rarely clears what’s already there. 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, see our guide to xanthelasma palpebrarum and browse all our xanthelasma guides.

Common Questions About What Causes Xanthelasma

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