A Colorful Enigma: A Case of Orange Palpebral Spots in a 63-Year-Old Woman

The thin, vascularized skin of the eyelids makes them prone to irritation and discoloration, potentially revealing underlying issues, such as subcutaneous deposits, and an abundance of pigments like carotenoids and lipofuscins. First described in 2008 by Assouly et al, orange palpebral spots (OPS) present as painless orange-yellow lesions on the upper eyelids, primarily affecting White women with Fitzpatrick skin types I to III. Despite various hypotheses, the exact cause of OPS remains elusive, with no established links to malignancy or systemic illnesses.

A 63-year-old woman, with a medical history including basal and squamous cell carcinoma, diabetes mellitus, hypertension, and hypercholesterolemia, was found to have asymptomatic orange-yellow patches on bilateral eyelids during a routine dermatological exam. There was no prior treatment for these lesions. A clinical diagnosis of OPS was made without obtaining biopsies.

Orange-yellow discoloration of the eyelids suggests lipid deposition in the dermis, leading to differentials including xanthelasma and carotenoderma. Biopsies of OPS show increased lipid deposition without xanthelasma's characteristic lipid-laden macrophages, also described as foamy histiocytes. Carotenoderma primarily affects sweat and sebum, leading to pigmentation in specific areas, like palms, soles, and nasolabial folds. Though the cause of OPS is unknown, factors like microscopic fat cells, increased pigments, and local trauma, are implicated. However, further research is needed to determine the etiology. Orange palpebral spots remain poorly recognized, with no established treatments, underscoring the need for accurate diagnosis to avoid unnecessary biopsies and provide reassurance to patients.