Random Dermatology MCQ - Xanthelasma Palpebrarum

A 38-year-old woman presents with bilateral, symmetric, well-demarcated orange-yellow plaques on her upper and lower eyelids. She has no other skin lesions and reports no visual symptoms. Her fasting lipid profile shows total cholesterol 220 mg/dL (normal <200) and LDL 140 mg/dL (normal <100). Which of the following is the most accurate statement regarding this condition?

A) These lesions always indicate underlying hyperlipidemia
B) The patient requires immediate systemic fibrate therapy
C) Approximately 50% of patients with these lesions have normal lipid levels
D) These lesions are pathognomonic for type III dysbetalipoproteinemia
E) Surgical excision is the first-line treatment

Correct Answer: C) Approximately 50% of patients with these lesions have normal lipid levels

Explanation

Key Features of Xanthelasma Palpebrarum:

1. Clinical Presentation:

   • Soft, yellow plaques on medial aspects of upper/lower eyelids

   • Bilateral and symmetric in 80% of cases

   • Often asymptomatic but may cause cosmetic concern

2. Association with Lipid Abnormalities:

   • 50% of patients have normal lipid levels

   • When abnormal, most commonly associated with:

     • Type IIa hypercholesterolemia (LDL receptor deficiency)

     • Type III dysbetalipoproteinemia (ApoE2)

3. Histopathology:

   • Clusters of foam cells in superficial dermis

   • No necrosis or inflammation

Management Approach:

1. First step: Complete fasting lipid profile

2. For normolipidemic patients:

   • Reassurance or cosmetic treatment (laser, cryotherapy, excision)

3. For hyperlipidemic patients:

   • Statin therapy (reduces cardiovascular risk and may slow progression)

   • Lesions often persist despite lipid control

Prognosis:

• Benign condition but may indicate increased cardiovascular risk when associated with dyslipidemia

• Recurrence common after removal (25-50%)