A Case Report of Xanthelasma and the Associated Differential Diagnosis

Xanthelasma, also known as xanthelasma palpebrarum, is a harmless, soft yellow plaque on or near the eyelids. A significant proportion of patients with xanthelasma have an underlying disease causing hyperlipidemia and should be evaluated for underlying causes. A 61-year-old woman presented to the emergency room for abdominal pain and lower extremity edema for two weeks. On physical exam, the patient was jaundiced with scleral icterus and asymptomatic bilateral yellow plaques on the medial aspect of the upper eyelids. The patient had a history of primary biliary cholangitis (PBC), and previous lab results were positive for anti-mitochondrial antibodies and Anti-smooth muscle antibodies. The patient's history and presentation were sufficient for the diagnosis of xanthelasma.  This case report describes an interesting case of xanthelasma and details the differential diagnosis that should be considered. The differential diagnosis includes necrobiotic xanthogranuloma, Erdheim-Chester disease, lipoid proteinosis, palpebral sarcoidosis, syringoma, sebaceous hyperplasia, and nodular basal cell carcinoma. Although xanthelasma can be easily diagnosed in some cases, other conditions on the differential should be considered to avoid delay in patient care.