At a Glance - Xanthelasma vs syringoma

Contributed by Dr Jean Watkins, a retired GP in Hampshire

Xanthelasma

Aetiology

  • Often occurs in patients with hyperlipidaemia, but can occur in patients with normal lipid levels.
  • More common in the 30-50 age range and in women.

Presentation

  • Soft, flat yellow plaques - occasionally calcareous.
  • Usually occur on the medial side of the upper eyelids.
  • Often symmetrically placed.
  • May remain static or grow in size but does not regress.
  • The function of the eyelid is not normally affected but occasionally ptosis develops.
  • Those with xanthelasma and corneal arcus have increased risk of ischaemic heart disease.

Management

  • Check fasting lipids and exclude diabetes.
  • Treat any underlying problem.
  • Treatment not necessary but sometimes requested by patients for cosmetic reasons.
  • Surgical excision.
  • Chemical cauterisation with trichloracetic acid - may lead to minimal scarring.
  • Cryotherapy - may require several treatments and may lead to scarring.
  • Carbon dioxide and argon laser treatment - may cause pigmentation and scarring.

Syringoma

Aetiology

  • Relatively common, benign tumour of the sweat glands.
  • More common in women.
  • Develop in puberty or adult life.
  • Occasionally associated with Down's, Marfan's and Ehlers-Danlos syndromes.
  • A family history of the condition.

Presentation

  • Skin-coloured or yellowish, rounded or flat topped papules, up to 3mm in size.
  • Usually in clusters on the upper part of the cheeks and lower eyelids.
  • Sometimes seen elsewhere, such as the axilla, chest, abdomen or genital areas.

Management

  • Treatment unnecessary but sometimes requested on cosmetic grounds.
  • Large numbers of lesions may be more troublesome to treat.
  • Electric needle inserted into the lesion and burst of low-voltage electricity to destroy the lesion. Effective and minimal scarring.
  • Surgical excision.
  • Cryotherapy.
  • Carbon dioxide laser ablation.
  • Trichloracetic acid.
  • Once destroyed, recurrence is unlikely.

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