Xantelasm is a new formation of a flat ovoid form of yellow color, localized on the face, mainly in the paraorbital region. This pathology can be observed as an independent disease, and in this case it is represented by a single plaque, or as a manifestation of diffuse xanthomatosis of the skin.
In most cases, xantelasms on the face are specific visually recognizable formations, so the differentiation of the diagnosis is not difficult. Medical measures in the detection of xantelasm should be complex in nature using the methods of conservative therapy (the use of drugs whose pharmacological action is aimed at correcting lipidogram disorders) and surgical correction (removal of xantelasm of the eyelids with the use of various surgical manuals).
The risk group for the development of xantelasm is older women. Given the pathogenetic mechanism of xanthelasm formation, its presence in the patient can be considered as an indirect criterion of atherosclerotic disease and an increased risk of development of ischemic damage to the myocardium and brain.
Causes of xantelasm
Despite the fact that the basic pathogenetic mechanisms of xanthelasm development are known to science, the main etiologic factor, which would lead to the formation of this disease in 100% of cases, is not reliably found. There are many predisposing causes for the development of xanthelasma, each of which is based on a damaging effect on lipid metabolism. A reliable fact is that in a situation in which multiple xantelasms are combined with a diffuse xanthomatous lesion of the skin, the patient exhibits pronounced changes in the analysis of lipidogram indices, which reflects a violation of cholesterol metabolism in the patient's body. Single xantelasms of the eyelids can develop without the participation of products of impaired metabolism of fats.
Given that there are a number of pathological conditions, accompanied by a violation of lipid metabolism, which include alimentary obesity , severe diabetes mellitus, cirrhotic liver damage and lipid nephrosis, xantelasm in patients suffering from these pathologies is often enough.
The congenital form of xanthomatosis with the accompanying development of xanthelasma is extremely rare and contributes to its development of genetically determined impaired lipid metabolism. In the case of an inherited xanthomatosis, clinical manifestations in the form of xanthelasm on the face appear in the infant during the neonatal period or in the early infancy.
Symptoms and signs of xanthelasm
The formation of xanthelasma is never accompanied by any other changes in the skin, especially inflammatory genesis. This pathology differs slowly progressive course, therefore at early stages the appearance of xantelasm does not disturb the patient and does not aggravate his health, which becomes the main reason for late treatment of the patient to a specialist.
A favorable fact is that under no circumstances can xantelism serve as a background disease for the development of malignancy, thereby excluding the possibility of developing a cancer-threatening life for the patient. The main reason why particularly female patients seek advice from a specialist is a cosmetic defect that develops with a pronounced increase in xanthelasm on the face.
In a situation in which xantelasm develops in a patient against a background of diffuse xanthomatosis, as a mapping of cholesterosis , plaques are usually located in the projection of the skin of the lower eyelid with simultaneous xanthomatous lesions of the skin on other parts of the trunk (neck, lateral thighs, paraarticular regions). With a massive diffuse lesion of the organism by xanthomatosis, plaque-like neoplasms can be visualized not only on the skin, but also on the mucous membranes of the oral cavity. In these situations, xanthomas and xanthelasmes look like small nodules, plaques or large deformed nodes that have a knobby surface and well-defined uneven contours.
With a close visual examination of the patient suffering from xantelasms, it is sometimes possible to detect plaques of various shapes and sizes, the parameters of which can reach 50 mm. It should be taken into account that the formation of xanthelasma in the patient has a persistent progressive course, and in medical practice there have not been cases of independent reverse development of this pathology. The formation of one xantelasm on the eyelid may be in one pore for a long time, but it can significantly increase in size and have a steady progression.
Finding the signs of xantelasm in a small child should be the reason for the parents' treatment of the child not only to the facial surgeon, but also the genetics, since in this situation, xanthelism acts as a clinical marker of a serious hereditary disease "hypercholesterolemic xanthomatosis". Given the complete absence of drug correction of this condition, the child subsequently develops severe complications with damage to the structures of bone, cardiovascular tissue and liver parenchyma.
Xantelasticity of the eyelids
At visual inspection of the paraorbital area of the patient, it is possible to detect a neoplasm of yellow color that rises above the level of the skin with localization in the projection of the inner corner of one or both eyes. As a rule, this neoplasm has all the qualities of "good quality", that is, its palpation does not cause discomfort and especially painful feelings in the patient, the consistency of xanthelasma is often mild. The location of xantelasm can be either symmetrical or one-sided. The defeat of the eyelids by xanthelasma means the predominant localization of the upper eyelid from one or both sides or an isolated lesion of the skin of the lower eyelid. The combination of both types of localization does not occur. With multiple lesions, individual neoplasms merge into conglomerates, which in some cases can have quite impressive dimensions. With prolonged flow, xanthelasm is observed to grow and spread throughout the century in the form of a plaque-like band.
A primary visit to the patient with eyelid xanthelasma to a specialist in the dermatological profile, as a rule, is accompanied by a detailed examination with the use of a compression of a slide, which is called a diascopy. This manipulation is performed with the aim of completely bleeding xantelasm for a more detailed study of the color and texture of the soft-tissue component. Nonspecific laboratory parameters of xantelasm are the detection of changes in lipid metabolism, so the patient enters the analysis of the lipidogram into the diagnostic procedure of the examination of this category by the patient.
Treatment of xantelasm
In a situation where the association of education in a patient with xanthelasm is reliably established with a violation of lipid metabolism and the accumulation of a high concentration of cholesterol in the blood, the primary action should be the elimination of the identified underlying causes. In some situations, the compensation of the main background disease ( diabetes mellitus , alimentary type of obesity, fatty hepatosis ) allows for a long period of time to stop the progression in increasing the size and quantity of xantelasm. To this end, the duty of the attending physician is to conduct a conversation with the patient on the topic of normalizing eating behavior and correcting the weight.
To normalize the lipidogram indices in most cases, it is sufficient to exclude from the diet foods saturated with cholesterol, which include: animal fats, fatty meat and fish, alcoholic beverages. In addition, the daily menu of the patient must be saturated with products that promote the cleavage and excretion of cholesterol from the body, which include all fermented milk products.
In a situation where the patient has significant deviations in lipidogram indices, the hypocholesterolemic diet should be supplemented with the appointment of an adequate scheme of lipotropic cholesterolemic drugs (Lipamid 0,025 g three times a day, Cetamiphen 0.5 g 3 times per day orally). The intake of drugs of this pharmacological group provides for a long course until the normalization of the analysis of the concentration of cholesterol in the blood.
After the operative treatment of xanthelasma, the patient must follow the recommendations on proper nutrition, and also the use of traditional non-traditional medicine that is aimed at preventing a possible recurrence of the disease. For example, a good effect on the prevention of scar formation in the postoperative period, as well as preventing the recurrence of the disease, has a dog rose collection. To make it, you just grind 100 g of rose hips, 75 grams of immortelle and 100 g of mint, then add 3 cups of boiling water to the herbal mixture and let it brew for three hours. The course of preventive treatment is at least 1 month of taking this infusion of 150 ml per day, regardless of food intake.
The most effective method of correction of xantelasm is the radical removal of one of the possible operational aids (electrocoagulation, exposure to liquid nitrogen, laser correction, surgical excision). All types of surgical treatment are a category of minimally invasive operations, and therefore, they do not require a long time and patient's introduction into general anesthesia.
Removal of xanthelasma by laser or any other method involves preliminary local anesthesia with Novocaine solution (2 ml of 0.5% solution concentration).
The operational manual on the removal of xantelasm provides for several manipulations. After adequate anesthesia, it is necessary to ensure maximum clipping of the plaque with tweezers and a scalpel, after which the edges of the operating wound should be burned with an electrocoagulator. In a situation where xantelasm has small parameters, the wound surface is not liable to stitching, but is processed by the albumin of iron, so that the wound heals with the formation of a strong scab within no more than seven days. If the wound surface after excision of xantelasm is large, it should be treated with a 10% solution of brilliant green and overlay the hair.
At the moment, laser coagulation is considered the most effective and at the same time low-traumatic surgical technique for the removal of xantelasm of the eyelid. The undeniable advantages of this treatment is the absence of postoperative complications and relapses, painlessness, minimal healing time for the wound surface and the absence of contraindications to its use. The average duration of laser coagulation is 15-30 minutes, therefore, it is advisable to use short-acting anesthetics as an anesthetic. The procedure involves the layer-by-layer action of the laser beam on the neoplasm within the healthy tissues, followed by treatment of the wound surface with an antiseptic solution. Under favorable conditions and observance by the patient of all the recommendations of the specialist who made laser coagulation, the healing process of a postoperative wound takes no more than two weeks.
In the remote postoperative period after the operation for the excision of xantelasm on the eyelid, it is possible to form dense scars, which cause a cosmetic defect and impede the mobility of the eyelid. To avoid the development of scar deformation, 0.5% hydrocortisone ointment should be used as a topical treatment twice a day for at least three weeks.
? Xantelasm - which doctor will help ? If there is or suspected development of xantelasm, you should immediately seek advice from such physicians as plastic surgeon, gastroenterologist and endocrinologist.