Xanthelasma What Causes It

What Causes Xanthelasma?

Xanthelasma is caused by cholesterol-rich fats leaking out of small blood vessels in the eyelid and being swallowed by immune cells, which swell into fat-filled “foam cells” and cluster into yellow plaques. What drives that leak differs: a blood fat disorder in about half of people, other conditions in some, and local eyelid factors in the rest.

Xanthelasma palpebrarum, to give it its full name, is the most common type of xanthoma, the family of fatty deposits that can form in skin and tendons. It shows up as soft, flat or slightly raised yellow spots on the eyelids, usually near the inner corners, and often on both sides. It affects around 1.1% of women and 0.3% of men, and most people notice it between 35 and 55.^[1]

The question “what causes it?” has two layers. The first is the same for everyone: cholesterol deposits on the eyelids are made of fat-loaded immune cells sitting in the skin. The second layer is personal: why the fat built up in your skin in the first place. Roughly half of people with xanthelasma have a primary or secondary blood fat disorder,^[1] which means the other half don’t, and that’s why every case deserves a simple check rather than an assumption.

This page walks through each cause in turn, then gets practical: how to find out which one is yours, and what that means when you want to get rid of xanthelasma. If you’d like the fuller medical background, our main guide to the causes of xanthelasma goes deeper, and why have I got xanthelasma helps you work out which cause fits your own situation.

How Do Xanthelasma Plaques Form In The Eyelid Skin?

Fats leak from the eyelid’s tiny blood vessels, immune cells called macrophages take them in, and once overloaded they become foam cells that collect around the vessels, with some inflammation. Thin eyelid skin and constant blinking make this spot especially prone to it.

The eyelids are a strange place for fat to settle until you look at how the skin there works. Researchers think the constant movement of blinking squeezes the tiny capillaries in the eyelid, and that these vessels become leakier as we age. Fat-carrying particles from the blood can then slip out into the surrounding skin.^[1] The process runs roughly like this:

1. Fats travel in the blood. Cholesterol and other fats are carried in particles called lipoproteins, including LDL.
2. They leak into the eyelid skin. Blinking pressure and age-related leakiness let some of those particles escape from the small vessels.^[1]
3. Immune cells clean up. Macrophages, the body’s clean-up cells, swallow the escaped fat.
4. The cells overload. When they take in more fat than they can process, they swell into foam cells.
5. Foam cells cluster. They gather in the deeper layer of the skin around the blood vessels, with some inflammation, and the yellow plaque appears.^[1]

This is why the color is so distinctive: you’re seeing stored fat through very thin skin. It also explains why the plaques don’t simply drain away once they’ve formed. The fat is locked inside living cells in the skin, not floating loose. Our guide to how xanthelasma forms follows this process step by step.

Is High Cholesterol The Main Cause Of Xanthelasma?

It’s the most common single cause, but not the only one. About half of people with xanthelasma have a blood fat disorder, most often raised LDL cholesterol, raised triglycerides or low HDL, and studies show people with xanthelasma have higher cholesterol on average than people without it.

The blood fat problems most often found with xanthelasma include raised LDL (the “bad” cholesterol), mixed patterns where both cholesterol and triglycerides are high, and low HDL (the “good” cholesterol).^[1] When researchers pooled 15 case-control studies covering 854 people with xanthelasma, they found higher total cholesterol, higher LDL and higher apolipoprotein B (the protein that carries LDL) than in people without it, along with lower apolipoprotein A1, the main protein in HDL.^[3]

Look at any one group of patients, though, and the picture is mixed. In one case-control study of 42 people with xanthelasma, 45.2% had high cholesterol and 54.8% had normal cholesterol. Average cholesterol was higher than in matched people without xanthelasma, and the clearest difference was low HDL: a median of 36.2 mg/dL against 50.5 mg/dL.^[2] In other words, a low “good” cholesterol can matter as much as a high “bad” one.

So yellow spots on the eyelids are a good reason to have your blood fats checked, but they’re not proof that your cholesterol is high. Our page on whether xanthelasma indicates raised cholesterol covers what your results might show, and what xanthelasma indicates looks at the wider picture.

Can Xanthelasma Be Caused By Your Genes?

Yes. Inherited cholesterol disorders, especially familial hypercholesterolemia, are a well-known cause. It affects about 1 in 250 to 1 in 500 people, passes from parent to child with a 50% chance each time, and can cause xanthelasma at a young age along with fatty lumps on tendons.

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

This matters far more than the look of the eyelids. Without medical care, about half of men with FH had a coronary event by 50, and about 30% of women by 60.^[5] Cholesterol-lowering medicines, usually statins, are the first-line approach, and they work best when started early.^[5] That’s why doctors pay particular attention to xanthelasma in younger people, where an inherited lipid disorder should be considered.^[1]

Read moreXanthoma Definition

Other inherited blood fat patterns can play a part too. In the case-control study above, about a quarter of patients (26.2%) had a family history of high blood fats.^[2] If your parents, brothers or sisters have high cholesterol, early heart disease, or yellow spots on their eyelids, tell your doctor. Our guide on whether xanthelasma is genetic explains the family side in more detail, and xanthomas covers the tendon type.

Which Other Conditions And Medicines Can Cause Xanthelasma?

Conditions that disturb blood fats can lead to xanthelasma, including diabetes, an underactive thyroid, a liver condition called primary biliary cholangitis, and the kidney condition nephrotic syndrome. Taking retinoid or estrogen medicines can also raise blood fats.

Doctors call these “secondary” causes, because the blood fat problem comes from something else. The ones linked with xanthelasma include:^[1]

• Diabetes. Poorly controlled blood sugar affects how the body handles fat, so a fasting glucose test, and HbA1c if you have diabetes, is part of the usual check.
• An underactive thyroid (hypothyroidism). A slow thyroid raises cholesterol, and it’s easy to miss because its symptoms, such as tiredness and weight gain, are so common.
• Primary biliary cholangitis. This liver condition, once called primary biliary cirrhosis, slows the flow of bile and produces an unusual fat particle called lipoprotein X.
• Nephrotic syndrome. A kidney condition that leaks protein into the urine and pushes cholesterol up.
• Medicines. Taking retinoid or estrogen medicines can raise blood fats in some people.
• Sarcoidosis. An inflammatory condition that has also been reported alongside xanthelasma.

The good news is that these are all things a doctor can test for and manage. Finding one of them is useful in its own right, because getting it under control helps your overall health, not just your eyelids. If you’re worried about what your plaques might mean, our guide on whether xanthelasma is dangerous puts the risks in proportion.

Why Do People With Normal Cholesterol Get Xanthelasma?

Because blood fat levels aren’t the whole story. Leakier eyelid vessels, blinking pressure, inflammation and the way immune cells handle fat all seem to play a part, so xanthelasma can form even when every blood test comes back normal.

This surprises many people. If the plaques are made of cholesterol, how can they appear when cholesterol is fine? The answer lies in the local process described above. Vessels in the eyelid become leakier with age and blinking keeps squeezing them,^[1] so even a normal amount of fat in the blood can slowly escape into the skin over the years.

The researchers behind the 42-patient study found no significant difference in the rate of high cholesterol or high triglycerides between people with and without xanthelasma, and concluded that local, hormonal or immune-cell factors probably contribute.^[2] The pooled analysis also found raised apolipoprotein B in people with xanthelasma,^[3] a measure that a standard cholesterol test doesn’t always report, so some people with “normal” results may still carry more of the particles that leak.

If your tests are normal, that’s good news for your health, and there’s no need to blame yourself for the plaques. It also means managing your cholesterol won’t change much about the plaques you already have, which is why people in this group usually go straight to thinking about removal. Our guide on why you might have xanthelasma with normal results covers this in more depth.

Who Is Most Likely To Get Xanthelasma?

Women in midlife are the most likely group, along with anyone with high LDL, low HDL, an inherited cholesterol disorder, diabetes, an underactive thyroid or certain liver conditions. It’s seen from about age 20 to 70, most often between 35 and 55.

Xanthelasma is close to four times more common in women than in men, and it’s usually noticed in middle age.^[1] In the 42-patient study, 85.7% were women and the average age was about 47.^[2] Some risk factors are fixed, while others are worth acting on:

Having one or more risk factors doesn’t mean you’ll get xanthelasma, and many people get it with none at all. If you’d like to understand how often it happens, our guide on how common xanthelasma is has the figures.

Can Diet Or Lifestyle Cause Xanthelasma?

Not directly. Diet and lifestyle affect your blood fats, and raised blood fats are one cause, so they can contribute in some people. But xanthelasma isn’t caused by one food, and many people with healthy habits still get it.

Because high LDL and low HDL are linked with xanthelasma,^[3] anything that pushes your cholesterol the wrong way can add to the risk. Eating a lot of saturated fat, carrying extra weight, being inactive and poorly controlled diabetes all tend to worsen blood fats in general. That’s why doctors often suggest diet and lifestyle changes alongside a cholesterol check.

Two points are worth keeping in mind. First, if your xanthelasma comes from an inherited disorder like FH, diet alone usually won’t be enough, and medicine is the main tool.^[5] Second, if your blood fats are already normal, changing your diet won’t change much about the cause. Our experience is that established plaques rarely shrink in any noticeable way with diet alone, so think of healthy eating as protecting your heart rather than as a way to clear the marks.

For food specifics, see what foods cause xanthelasma and what to eat for xanthelasma, and our guide on how to prevent xanthelasma puts the habits together.

What Doesn’t Cause Xanthelasma?

Xanthelasma isn’t an infection, it isn’t contagious, it isn’t cancer, and it isn’t caused by makeup, skincare or rubbing your eyes. It’s a buildup of fat-filled cells in the skin.

Read moreHow To Get Rid Of Xanthelasma Under Eyes

A lot of worry comes from not knowing what these fatty deposits around the eyes are. You can’t catch xanthelasma from someone or pass it on by touch. It isn’t a growth that turns into cancer, as our guide on whether xanthelasma can be cancerous explains. And it isn’t a sign that you’ve been washing your face wrongly or using the wrong cream.

It’s also usually not something you did. Even when blood fats are involved, genes, age and other health conditions often play a bigger part than any one habit. What it is, though, is a useful signal to have a health check, and a cosmetic concern you’re entitled to deal with if it bothers you. Because the fat sits inside cells in the skin, it can’t be squeezed or popped out either, and trying risks infection and scarring.

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 taking cholesterol into account. That’s the main reason to find your cause: it’s about protecting your heart as much as your eyelids.

In a Danish study that followed almost 13,000 people from the general population for decades, people with xanthelasma had a higher risk of heart attack and ischemic heart disease, and this link held regardless of their cholesterol levels.^[4] The pooled analysis of 15 studies also found thicker carotid artery walls in people with xanthelasma, a sign of early hardening of the arteries.^[3]

The risk is about patterns across large groups. It doesn’t mean your heart is in danger. But it does mean that xanthelasma is a good moment to check your blood pressure, cholesterol, blood sugar and family history with a doctor, especially if you’re young, a man, a smoker or have relatives with early heart disease. If an inherited disorder like FH turns up, early care makes a real difference.^[5]

How Do You Find Out What Caused Your Xanthelasma?

See your family doctor for a fasting lipid profile, plus liver, thyroid and blood sugar tests. Together with your family history, these find most causes. If the diagnosis is uncertain, a dermatologist can confirm it.

The workup is simple and usually takes one blood draw. The tests doctors use to look for the cause of xanthelasma are:^[1]

1. Fasting lipid profile. Measures total cholesterol, LDL, HDL and triglycerides, and finds the most common cause.
2. Liver panel. Checks for liver conditions such as primary biliary cholangitis.
3. Thyroid function tests. Look for an underactive thyroid.
4. Fasting glucose, and HbA1c if you have diabetes. Checks blood sugar control.
5. Family history and examination. Your doctor will ask about relatives with high cholesterol or early heart disease and may look for tendon lumps that point to FH.
6. A skin biopsy, only if unsure. Rarely needed, but it confirms the diagnosis if the plaques look unusual.

Bring a list of your medicines, and mention any relatives with high cholesterol or heart problems. Your family doctor is the right first stop; our guide on which doctor to see about xanthelasma explains when a dermatologist, eye specialist or lipid clinic comes in.

Does Knowing The Cause Help You Get Rid Of Xanthelasma?

Knowing the cause protects your health and can slow new plaques, but it won’t remove the plaques you already have. For that you need a removal method, either at a clinic or at home.

Once the fat is locked inside cells in your skin, lowering your cholesterol doesn’t empty them out in any reliable way, and xanthelasma rarely clears up by itself, as our guide on whether xanthelasma can go away on its own explains. So most people follow two tracks at once: manage the cause with their doctor, and deal with the plaques separately.

Clinic removal works. A review of 49 studies found that CO2 laser gave more than 75% improvement in over 90% of patients, and Er:YAG laser gave more than 80% improvement. Changes in skin color were the most common complication, and surgery tends to be used for larger, deeper plaques.^[6] Surgery can carry risks such as the lower lid pulling outward, and freezing or chemical methods can scar or discolor the skin.^[1] Costs vary widely by clinic and method; our guide to how much xanthelasma removal costs covers what affects the price.

Many people would rather avoid a clinic and handle smaller plaques at home. Our guides to the removal of xanthelasma and how to get rid of xanthelasma compare every option side by side.

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.

Why Can Xanthelasma Come Back After Removal?

Because removal clears the plaque but not the cause. If the conditions that made fat collect in your eyelids are still there, new plaques can form. Recurrence after removal is generally under 50%, and deeper plaques come back more often.

Read moreWhat Is The Meaning Of Xanthelasma In Medical Term

Recurrence is part of the picture with every removal method, whether laser, surgery or anything else. It’s generally reported at under 50%, it’s higher after repeated procedures, and plaques that reach deeper into the skin are more likely to return.^[1] That isn’t a failure of the method; it reflects the fact that the cause of xanthelasma is an ongoing process in the body.

This is where knowing your cause pays off. If your cholesterol is high, your thyroid is slow or your diabetes is poorly controlled, getting those under control gives you the best chance of fewer new plaques. If your tests are normal, new plaques may still appear over time simply because of the local eyelid factors. Our guide on whether xanthelasma comes back covers recurrence in more detail.

What’s The Bottom Line On What Causes Xanthelasma?

Xanthelasma is caused by fat from the blood collecting in immune cells in the eyelid skin. About half of people have a blood fat disorder behind it, some have diabetes, thyroid or liver problems, and the rest have normal tests and local eyelid factors.

The practical plan is simple. Have a blood test to find your cause, because that’s about your heart and your health. Then, if the plaques bother you, choose how to remove them, because managing the cause won’t clear 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, our guide to xanthelasma cream, and browse all our xanthelasma guides.

Common Questions About What Causes Xanthelasma