Causes Symptoms Diagnostics Treatment Advantages of treatment at MGK Prices
Xanthelasmas of the eyelids look like small single or multiple flat yellowish plaques located at the inner corner of the upper (usually) or lower eyelid. Xanthelasmas are benign formations that are not prone to malignancy; their appearance is associated with general disorders of lipid metabolism.
Prices for treatment for xanthelasma
The cost of surgical treatment of xanthelasma starts from 2000 rubles. (in the presence of a single formation up to 5 mm). The final cost of removal will depend on the number and size of formations, as well as the volume of therapeutic and diagnostic procedures performed.
You can find out the cost of a particular procedure by calling (499) 322-36-36 or online using the appropriate form on the website; you can also read the “Prices” section.
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Cryodestruction
This is a method of removing skin lesions - xanthelasmas, warts, papillomas - by freezing with liquid nitrogen. The procedure gives a good cosmetic effect. The fatty plaque is frozen at an ultra-low temperature of 190 degrees, after which its structure is destroyed and cell growth stops. During the rehabilitation period, you must strictly follow the care recommendations: protect your eyes from the bright sun, do not visit the solarium, and do not use facial cosmetics.
Symptoms
Xanthelasmas of the eyelids are rounded plaques slightly protruding above the surface of the skin, pale yellow in color, and their consistency is soft. The size of such formations can vary from several millimeters to 1.5 cm; the elements themselves can be either single or multiple. In some patients, xanthelasmas may appear as a solid yellowish stripe extending onto the bridge of the nose.
Xanthelasmas in the lower eyelid area (xanthomas) are rarely isolated; they usually occur in addition to the same formations located on the upper eyelid and are a manifestation of xanthomatosis. Patients with xanthelasmas of the eyelids do not present any complaints; the formations are painless and represent mainly a cosmetic defect. Once occurring, xanthomas and xanthelasmas remain for life, very slowly increasing in size.
Prevention
There are no exact recommendations for prevention of xanthelasma.
Need to know! Experts can only give general recommendations that will help patients get out of the risk group and avoid the appearance of such formations with age:
- monitor your weight and introduce more healthy foods into your diet;
- add foods containing fiber , and also eat up to three hundred grams of vegetables and fruits daily;
- Replace animal fats with vegetable fats , but consume them in reasonable quantities;
- drink at least 1.5 liters of water per day ;
- exercise regularly ;
- try to give up smoking and alcohol ;
- control metabolism , if necessary, visit a nutritionist and endocrinologist.
Diagnostics
Patients with xanthelasma of the eyelids need to consult not only an ophthalmologist, but also an endocrinologist and a dermatologist. The examination must include a general blood test, a study of lipid metabolism (level of lipoproteins and cholesterol in the blood serum).
The characteristic appearance of the formations usually does not pose any difficulties in making a diagnosis. In addition to xanthelasmas and xanthomas, the patient is often diagnosed with obesity, hypertension, metabolic syndrome or diabetes mellitus. Xanthelasma of the eyelids must be differentiated from other similar skin diseases (syringoma, pseudoxanthoma), incl. malignant tumors.
Common xanthoma
- Xanthoma-like lesions are caused by a rare form of histiocytosis.
- Lipid metabolism is normal.
- The skin lesions usually consist of hundreds of small yellowish-brown or reddish-brown bumps that are usually evenly distributed on both sides of the face and torso. They can be especially hard on the armpits and groin.
- Small bumps may join together to form sheets of thickened skin.
- In 30% of affected people, the mucous membranes of the mouth, respiratory tract or eyes (mucous membranes) are affected. Warty plaques in the mouth are called verruciform xanthoma.
- 40% of affected people develop diabetes insipidus, a condition that results in an inability to control water loss (leading to constant thirst and excessive urine production). This occurs due to the overgrowth of histiocytes on the lining of the brain (meninges).
- May affect internal organs (eg liver, lungs, kidneys, etc.)
- Self-limiting and eventually improves on its own, but may persist for many years.
Treatment of xanthelasma of the eyelids
Since xanthelasmas and xanthelomas in most cases accompany lipid metabolism disorders, liver disease, etc., it is imperative to treat the underlying disease. It is recommended to follow a diet limiting the consumption of animal fats and replacing them with vegetable fats. If hypercholesterolemia is detected, drugs that normalize lipid metabolism (statins, lipoic acid, berlition) are prescribed. The use of drugs that normalize liver function (choleretic agents, Essentiale, multivitamins) is indicated.
There is no drug treatment for xanthelasma of the eyelid; the formation (at the request of the patient) is removed using a laser, electrocoagulation or surgery. The intervention is performed under local infiltration anesthesia. During removal, a specialist uses tweezers and miniature scissors to separate the base of the plaque, then treats the skin in the wound area with an antiseptic. If the size of the lesion to be removed is not large, the edges of the wound are treated with a solution of iron albuminate, which promotes effective healing. In the case of a more extensive wound surface, its edges are treated with electric current (diathermy) or cosmetic sutures are applied.
Diet
Diet for vascular atherosclerosis
- Efficacy: therapeutic effect after 2 months
- Dates: no data
- Cost of products: 1700-1800 rubles. in Week
In the diet it is necessary to exclude/significantly limit:
- Saturated fats (all animal fats, butter, and coconut and palm oils).
- Foods rich in cholesterol (egg yolks, liver, kidneys, butter, high-fat fats, ghee, fish roe, shrimp).
- Simple carbohydrates (various sweets, confectionery, sweet carbonated drinks, ice cream, condensed milk).
Olive oil, legumes and plenty of vegetables (Mediterranean diet) should form the basis of a cholesterol-lowering diet. A diet low in animal fats, simple carbohydrates and high in fiber can normalize slightly elevated lipid levels. To do this, you need mainly dishes from vegetables in any form, fish, legumes and grains. If you are obese or overweight, it is important to reduce your intake of high-calorie foods and at the same time increase physical activity.
Advantages of xanthelasma treatment and prices at MGK
By contacting the Moscow Eye Clinic, you can be assured of a quick and reliable diagnosis of xanthelasma of the eyelid and its effective treatment. Removal of xanthelasma of the eyelid can only be performed by a specialist with appropriate professional skills. To avoid possible complications, this procedure should be entrusted to an experienced doctor. At the Moscow Eye Clinic you will be able to undergo all the necessary tests, based on the results of which the attending physician will recommend you the most effective treatment methods. The Clinic employs specialists with extensive professional experience who enjoy well-deserved respect both among colleagues and among patients.
Removal of xanthelasma of the eyelid is performed on an outpatient basis under local anesthesia. During the operation, sterile instruments and disposable consumables are used, which eliminates the risk of infectious complications.
Author:
Yakovleva Yulia Valerievna 5/5 (1 rating)
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Xanthelasma of the eyelids appears in the form of plaques with clear boundaries of straw-yellow or orange color. They are soft, painless, ranging in size from small peas to large beans [1-4]. The occurrence and further growth of xanthelasma is not accompanied by subjective sensations; it only creates a cosmetic defect.
The etiopathogenesis of the development of xanthelasma involves dyslipidemia: primary - occurs as a result of mutations in genes that implement the function of receptors, enzymes and transport proteins involved in lipid metabolism; secondary - caused by certain diseases (diabetes mellitus, pancreatitis, cholecystitis, hepatitis, nephrotic syndrome, etc.) and drugs (estrogens, corticosteroids) [1-5].
Various methods for treating xanthelasma have been developed: surgical excision, cryodestruction, electrocoagulation, laser therapy, and the use of mono-, di- and trichloroacetic acid (TCA) [6-13]. Unfortunately, each of these methods cannot be called optimal, since all of them are not without drawbacks that complicate the patient’s life.
We settled on the use of TCA - a method that is easier to use and quite effective. The acid, acting on the skin, provokes coagulation of proteins, which results in the formation of salts and the skin becomes whitish in color. Among the publications, we found works on the use of 50, 70 and 100% concentrations of TCA [11].
W. Coleman and J. Futrell [12] found that the depth of penetration of TCA into the skin depends on its concentration and exposure time: the higher the concentration, the deeper the penetration. However, this increases the likelihood of complications (scar formation, persistent hypo- or hyperpigmented spots).
Unfortunately, in clinical practice they are most often limited to local therapy only, without paying attention to the root cause - dyslipidemia.
The purpose of our study is to study the effectiveness of combination therapy - the combined use of lipid-lowering drugs and the direct effect of an application of 20% TCA on xanthelasma plaques.
Material and methods
The study involved 62 patients - 12 (19.35%) men, 50 (80.65%) women - aged 22-63 years (77.4% - 50 years old). After a 12-hour fast, venous blood was taken from patients to study the lipid profile.
Depending on the clinical manifestations, xanthelasmas were conditionally divided into 3 forms: 6 (9.7%) patients had macular form, 46 (74.2%) patients had plaque form, 10 (16.1%) patients had papular form. Patients were photographed before and after treatment (Fig. 1 and 2)
.
Figure 1. Clinical manifestations of the plaque form of xanthelasma before (a) and after (b) treatment.
Figure 2. Clinical manifestations of the macular form of xanthelasma before (a) and after (b) treatment.
Local treatment consisted of applying an application of 20% TCA. Then the lesion was treated with an ointment containing an antibiotic. Local therapy was administered to all patients regardless of blood lipid levels. The frequency of application depended on the form of xanthelasma (until complete regeneration). The interval between procedures was 21 days.
To correct dyslipidemia, the lipid-lowering drug rosuvastatin (Rosucard) was used.
Treatment results were determined 6 months after the last application.
results
When studying the lipid spectrum of the blood, the following changes were revealed: increased levels of total cholesterol - in 55 (88.75%) patients, triglycerides - in 39 (62.9%), low-density lipoproteins - in 47 (75.8%), lipoproteins very low density - in 21 (33.3%). Against this background, 19 (30.6%) patients had a reduced level of high-density lipoproteins. Dyslipidemia was not detected in 4 patients.
Type IIa dyslipidemia was diagnosed in 38 (61.3%) cases, type IIb - in 15 (24.2%), type III - in 3 (4.8%), hypo-α-lipoproteinemia - in 2 (3.2%). %). Patients with dyslipidemia used the lipid-lowering drug rosuvastatin (Rosucard) 10 mg daily for 3 months.
The effectiveness of combination therapy was assessed by the disappearance of clinical manifestations of the disease (see table)
.
We found that with the spotted form, one application was enough for recovery.
For plaque xanthelasma, 7 patients underwent 3 applications, the rest - 2. All patients with the papular form underwent the procedure 3 times. We compared the data obtained with previously published results. Thus, V. Ramesh and M. Haque [11] used 50, 70 and 100% TCA in the treatment of xanthelasma. They showed that the treatment effect depends on the acid concentration. They obtained excellent results in 100% of patients with papulonodular (100% TCA solution) and plaque (100 and 70% TCA solution) forms. All patients with xanthelasma maculae achieved a satisfactory result after treatment with a 50% TCA solution.
When using the combination therapy regimen we proposed (depending on the form of xanthelasma), an excellent therapeutic effect was obtained in 100% of patients with the macular form, in 93.5% with the plaque form, and in 80% with the papular form of xanthelasma.
In 60% of patients with the papulonodular form and in ⅓ of patients with fatty plaques, V. Ramesh and M. Haque [11] used 3-4 applications of 50 and 70% TCA. In our study, 3-time applications were used only in 17 (27.4%) patients, and 4-time applications were not used.
T. Nahas and J. Marques [13] used 70% TCA for the treatment of xanthelasma. Their study recorded 45.8, 33.4 and 20.8% excellent, good and satisfactory ratings respectively, i.e. in our study there were 1.7 times more excellent results, and 2.6 times less satisfactory results. T. Nahas and J. Marques [13] had 1.5 times fewer patients without complications (45.8%) than in our studies (79%). The most common complications, according to the authors of the publication, are hypopigmentation (33.3%), hyperpigmentation (12.5%). Our result was exactly the opposite: hyperpigmentation occurred 5.6 times more often (70.9% of cases), and hypopigmentation occurred 1.6 times less often (20.9%). The relapse rate, according to T. Nahas and J. Marques [13], was 25%, which was 1.7 times higher than the value of the same indicator with combined treatment (14.3%).
conclusions
Thus, when treating xanthelasma, we obtained a 100% cosmetic effect. Using TCA in a fairly weak concentration (20%), we achieved a significant therapeutic effect. Firstly, in our studies, 72.5% of patients needed only 1-2 applications of TCA, i.e. reductions in treatment time and cost savings were obtained. Secondly, 20% TCA significantly reduces injuries, which in turn reduces the number of patients with complications by 1.5 times compared to published data. In our opinion, this effect became possible only due to the simultaneous treatment of dyslipidemia. The treatment regimen we propose is equally effective in treating all forms of xanthelasma, is simple, and allows you to achieve an excellent cosmetic effect with minimal, quickly transient side effects.
