Bilateral Circular Xanthelasma Palpebrarum

Xanthelasma palpebrarum is the most common cutaneous xanthoma. It is most often around the medial side of the eyelids, and typically presents in middle-aged and older adults [1]. A case of bilateral extensive xanthelasma palpebrarum that involves the entire upper and lower eyelids, resembling a pair of circles, has not been reported. A 53-year-old female visited our department complaining of bilateral circular yellowish skin lesions around the upper and lower eyelids (Fig. 1). The lesions started to appear one year prior to admission at the medial aspect of the upper and lower eyelids and spread to the lateral sides. The patient complained that she felt inconvenienced or that opening her eyelids felt somewhat heavy and worried about the cosmetic appearance. Based on the clinical manifestation alone, the diagnosis of xanthelasma palpebrarum could be made. The patient was otherwise healthy, and her medical history was noncontributory. She had no history of using medication for hyperlipidemia or cardiovascular disease. Her parents had no history of xanthelasma palpebrarum. She had seven siblings. No one in her family had used medication for cardiovascular diseases such as hypertension, hyperlipidemia, or diabetes. Among them, only one sister had experienced xanthelasma palpebrarum, which had been limited to the medial side of the upper eyelid, and she had been treated with laser ablation in a local dermatology clinic. Fig. 1 Preoperative view. A 53-year-old female presented bilateral circular yellowish skin lesions around the upper and lower eyelids. On physical examination, the yellowish flat lesions involved both the upper and lower eyelids, resembling a pair of circles. The lesions of the medial side of both of the upper eyelids were especially large and the other sides were linear and curved. The sizes (horizontal length × largest longitudinal height) were: 35×8 mm (right upper eyelid); 40×9 mm (left upper eyelid); 30×5 mm (right lower eyelid); and 50×5 mm (left lower eyelid). There was no limitation of the extraocular muscle movement. Laboratory tests were evaluated before surgery. The total cholesterol, high-density lipoprotein cholesterol, and triglyceride levels were 255 mg/dL (range, 120 to 220 mg/dL), 52 mg/dL (range, 35 to 88 mg/dL), and 109 mg/dL (