Rapid resolution of xanthelasmas after treatment with alirocumab

Xanthelasmas are superficial fat deposits around the eyelids commonly present in different hyperlipidemias and associated with increased cardiovascular risk. Statins or other lipid-lowering treatments do not usually modify them. We present the case of a middle-age man with severe high levels of LDL cholesterol from youth due to a genetically defined heterozygous familiar hypercholesterolemia (HeFH). He presented large xanthelasmas of both inner eyelids in spite of long term treatment with statins and ezetimibe that disappeared after treatment with alirocumab75 mg every 2 weeks for 26 months. His LDL cholesterol went from 164 mg/dL to 47 mg/dL with alirocumab. Xanthelasma regression was not previously reported with lipid-lowering drugs in HeFH. This case demonstrates that regression of skin lipid lesions can be achieved with very low LDL cholesterol concentrations.