Xanthelasma

[Timótheos]

I was wondering if anyone is familiar with or had experience in the treatment of a condition called Xanthelasma?

http://en.wikipedia.org/wiki/Xanthelasma
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002418/
http://emedicine.medscape.com/article/1213423-overview

It is most commonly characterized by the build-up of yellow fatty deposits around the eyelid area.

It's mostly a cosmetic problem for people and not a serious health issue, although there seems to be some evidence that the presence of these lesions can indicate a high serum cholesterol and can be an early warning symptom of heart disease.

http://www.dailymail.co.uk/health/article-2038092/Yellow-eyelid-marks-xanthelasma-early-warning-sign-heart-disease.html

Some basic treatments include laser, cosmetic surgery, cryotherapy and application of strong vinegar (trichloroacetic acid). The latter has only a 60% success rate and can cause scarring or pigmentation issues after application. There is an interesting video on youtube that shows an effective treatment using a waterlase, which from what I can tell is a dental hygiene cleaning tool.

http://www.youtube.com/watch?v=Us6KoJIxqVQ

also with a CO2 laser here...

http://www.youtube.com/watch?v=1ZxmWuspmHk

Anyway, if anyone has information regarding this topic, it would be much appreciated.

 

[Laura]

I've always heard that it was evidence of a liver problem. A friend of ours had it really bad and once he cut out all carbs and went low carb (not keto) they went away. Then, he fell off the wagon, started eating jellies and very sweet coffee and drinks, and they came back. He also lost his leg to severe arterial occlusion.

 

[mcb]

I was wondering if anyone is familiar with or had experience in the treatment of a condition called Xanthelasma?
...

I have it, though it is not terribly noticeable -- discolored patches just above the inner corners. A doctor diagnosed it as "cholesterol deposits" years ago, and said it could be corrected with cosmetic surgery. At my expense, of course, because my HMO at the time didn't pay for such things. I didn't do anything about it.

Out of curiosity I took a look just now (I rarely check it) and it seems to have improved somewhat with the ketogenic diet (at somewhere around 18 months in).

Megan

 

[Nienna]

I was wondering if anyone is familiar with or had experience in the treatment of a condition called Xanthelasma?
...

I have it, though it is not terribly noticeable -- discolored patches just above the inner corners. A doctor diagnosed it as "cholesterol deposits" years ago, and said it could be corrected with cosmetic surgery. At my expense, of course, because my HMO at the time didn't pay for such things. I didn't do anything about it.

Same here and I was told the same thing by my doctor, that they are cholesterol deposits and they are nothing to worry about. I basically forget about them.

Out of curiosity I took a look just now (I rarely check it) and it seems to have improved somewhat with the ketogenic diet (at somewhere around 18 months in).

Megan

Same here, again. I just went and looked at them, they are not very noticeable, to me at least. And no one, in recent times, has ever mentioned them. They seem to be not as pronounced as they were years ago.

 

[Timótheos]

In my case, they showed up about 3-4 years ago, before I started on any sort of diet. One day I just noticed them being there, it didn't seem like a gradual thing at all. I went to a dermatologist and she suggested the TCA Acid application, but after doing some research, the risk/benefit ratio didn't seem worth the trouble. They're not uncomfortable in any way, just strange and rather unsightly.

I had some blood work done this summer and my liver enzyme profile was within normal range, however some my blood lipid levels were outside what is usually acceptable. I'm having a little trouble interpreting the results as mine were measured in mmol/L, whereas most profiles and information online use mg/dl. Maybe psyche, if she gets a chance, can have a look at these numbers and let me know if there is anything in there worth looking into...

Cholesterol - 11.86 mmol/L
HDL Cholesterol - 1.03 mmol/L
Triglyceride - .98 mmol/L
LDL Cholesterol - 10.38 mmol/L
Cholesterol, Total/HDL Ratio - 11.5

 

[Palinurus]

Hi Timótheos,

I just googled mmol/l = mg/dl and got several sites doing the conversions for you.

This was one of them: _http://en.mte.cz/conversion.php

Hope this helps a bit. :)

 

[Gaby]

I found a calculator here. Lets have a look:

http://www.onlineconversion.com/cholesterol.htm

Total cholesterol 458.62336 mg/dl

HDL Cholesterol 39.82985 mg/dl

Triglyceride 86.80248 mg/dl

LDL Cholesterol 401.39211 mg/dl

The triglycerides are low and HDL normal, reflecting a low carb diet. But LDL is very high indeed. It looks to me like it could be familial hypercholesterolemia which is genetic. Xanthelasmas are more frequent in this condition as well.

I would find out about ultrasensible (sp?) C-reactive protein and HbA1c (glycated Hb) to have an idea of glycation levels and if you are having systemic inflammation going on.

Nickleblue was having a similar cholesterol panel and was researching about it too.

 

[Timótheos]

I would find out about ultrasensible (sp?) C-reactive protein and HbA1c (glycated Hb) to have an idea of glycation levels and if you are having systemic inflammation going on.

Thanks for the feedback Psyche and Palinurus.

FYI,
my C-reactive protein levels came out to <2.0 (<9) mg/L
and the HB A1C levels read as 5.4 (4.3-6.1)

and these results are after 15 hours of fasting, taken at the end of August last year.

 

[Laura]

and these results are after 15 hours of fasting, taken at the end of August last year.

How long have you been paleo? If so, what is your daily carb count? What form of carbs? What about ketogenic, have you opted in that direction? If so, how long?

Might be important to know these things in order to assess the situation.

 

[Laura]

Looking at the familial hypercholesterolemia, it appears that this might be something that could be controlled by activation of wild mtDNA which the protein restricting ketogenic diet combined with hard/fast/heavy workouts is designed to do.

ADDED:

The Wikipedia article about it says:

Heterozygous FH is normally treated with statins, bile acid sequestrants or other hypolipidemic agents that lower cholesterol levels. New cases are generally offered genetic counseling. Homozygous FH often does not respond to medical therapy and may require other treatments, including LDL apheresis (removal of LDL in a method similar to dialysis) and occasionally liver transplantation.

So maybe what I heard years ago - that it is a liver problem - is correct. That might mean a real need to get the liver up and running in a regular way, though it would need support in the way of digestive enzymes in the beginning. It might also mean that such a system is one that is particularly sensitive to carbs and especially, the deadly combination of carbs and fats.

My thought is that, if you have these things showing up at your young age, it is definitely time to get really serious about getting to the bottom of things.

 

[Gaby]

Looking at the familial hypercholesterolemia, it appears that this might be something that could be controlled by activation of wild mtDNA which the protein restricting ketogenic diet combined with hard/fast/heavy workouts is designed to do.

And considering that according to this paper, lowering cholesterol has a limited effect on endothelial function (meaning that reducing cholesterol doesn't make a difference), a mitochondrial healing approach would probably be the best way to go. Same paper says that improving the anti-oxidant status with vitamin C and vitamin E has made a difference:

[A randomized single-blind trial of the effects of vitamins C and E in familial hypercholesterolemia].

_http://www.ncbi.nlm.nih.gov/pubmed/16948972

[...] These modifications are independent of the degree of dyslipidemia and may represent an indicator of reduced cardiovascular risk.

Here is another article:

Antioxidant vitamins C and E improve endothelial function in children with hyperlipidemia: Endothelial Assessment of Risk from Lipids in Youth (EARLY) Trial.

_http://www.ncbi.nlm.nih.gov/pubmed/12912807

The endothelium preserves vascular integrity and prevents atherosclerosis by modulating vasomotor tone, platelet activity, thrombosis, and inflammation.6 Increased vascular oxidative stress in hypercholesterolemia contributes to impaired endothelial function and atherogenesis.7 Endothelial dysfunction is characterized by reduced bioavailability of nitric oxide (NO) through decreased production and/or increased degradation of NO in oxidative stress.8 Reactive oxygen-derived free radicals may promote LDL oxidation in the vascular wall and attenuate endothelium-dependent vasodilation.9 Recent studies indicate that endothelial dysfunction of the coronary and brachial arteries is associated with future adverse cardiovascular events.10,11

Epidemiological evidence suggests that increased intake of dietary antioxidants reduces the risk for CHD.12,13 Antioxidant vitamins may provide vascular defense against oxidative stress by scavenging free radicals and protecting NO from inactivation.14,15 Antioxidant administration improves endothelial function of coronary and peripheral vessels in hypercholesterolemia and CHD.14,15 A previous study also suggests that antioxidants may improve endothelial health in hyperlipidemic children.3 [...]

Biomarkers for oxidative stress and inflammation may be helpful indicators of the progression of subclinical atherosclerosis in hyperlipidemia.

[...]

Vitamin E alone decreases ROS and apoptosis in endothelial cells induced by OxLDL.44 Moreover, the combination of vitamins C and E has been shown to protect endothelial cells from the cytotoxic effects of OxLDL.45 Antioxidants may also enhance endothelial NO synthase (eNOS) activity. A previous study showed that eNOS activity is impaired in hypercholesterolemia.46

[...]

In conclusion, we have demonstrated that moderate daily doses of vitamins C and E restore endothelial function in hyperlipidemic children. This effect was most likely mediated at the level of the vascular wall and in our short term study was not associated with changes in plasma biomarkers of oxidative stress, inflammation, or ADMA. Antioxidant vitamins C and E may improve endothelial function by increasing local NO bioavailability and may therefore retard the progression of atherosclerosis in high-risk children.

The above-mentioned parameters and anti-oxidant status are things that are improve on the diet.

 

[Alana]

Looking at the familial hypercholesterolemia, it appears that this might be something that could be controlled by activation of wild mtDNA which the protein restricting ketogenic diet combined with hard/fast/heavy workouts is designed to do.

ADDED:

The Wikipedia article about it says:

Heterozygous FH is normally treated with statins, bile acid sequestrants or other hypolipidemic agents that lower cholesterol levels. New cases are generally offered genetic counseling. Homozygous FH often does not respond to medical therapy and may require other treatments, including LDL apheresis (removal of LDL in a method similar to dialysis) and occasionally liver transplantation.

So maybe what I heard years ago - that it is a liver problem - is correct. That might mean a real need to get the liver up and running in a regular way, though it would need support in the way of digestive enzymes in the beginning. It might also mean that such a system is one that is particularly sensitive to carbs and especially, the deadly combination of carbs and fats.

My thought is that, if you have these things showing up at your young age, it is definitely time to get really serious about getting to the bottom of things.

I found this info also on the net, the first one mentioning liver problems and the second one heart issues:

http://cms.revoptom.com/handbook/March_2004/sec1_5.htm

XANTHELASMA
Signs and Symptoms

Xanthelasma are seen clinically as oval or elongated yellowish plaques just beneath the skin of the periorbital region. Most commonly, they are noted near the inner canthus of the upper eyelid, although they may be seen on the lower lid as well; they are generally symmetrical in presentation. Inspection and palpation may reveal a soft, semisolid, or calcified texture.

Patients with xanthelasma are typically over 40 years of age, and women are affected nearly twice as often as men.1 The condition may be seen in light-skinned and dark-skinned individuals. Patients with xanthelasma may present because of a cosmetic concern, or the condition may be detected on routine ocular examination. The lesions are neither inflammatory nor painful, and there is no tendency toward malignancy, although the lesions may enlarge and/or coalesce over time. In very rare instances, abnormally large xanthelasmas can interfere with lid function, causing ptosis or lagophthalmos.

Pathophysiology

Xanthelasma palpebrarum represents a common form of xanthoma, a cutaneous deposit of fatty materials. The term "xanthelasma" is extremely descriptive; it is derived from the Greek xanthos (meaning yellow) and elasma (meaning plate). Histological evaluation of these lesions reveals an accumulation of lipid-laden macrophages, termed histiocytes, within the dermis.

Although a link has been suggested between xanthelasma and hyperlipidemia, only about half of patients with these lesions demonstrate elevated serum lipid levels. However, younger individuals with xanthelasma have a proportionally greater likelihood of hyperlipidemia and hypercholesterolemia than do older individuals.2,3

Management

In most cases, xanthelasma is diagnosed by the clinical appearance alone, though atypical presentations may prompt the clinician to obtain a biopsy. Laboratory testing of serum lipids is also recommended.

While xanthelasma is essentially benign, many patients consider the condition to be cosmetically unacceptable, and opt for removal. Treatment modalities are quite numerous, and include such diverse options as: (1) use of chemocautery agents, such as trichloracetic acid; (2) electrodessication; (3) cryotherapy; (4) CO2 or argon laser ablation; or (5) surgical excision. Scar formation and pigmentary changes are the most common complications of laser or chemotherapy. Chemical cautery and surgical excision tend to produce better results with less risk of subsequent scarring.

Clinical Pearls

While we know that xanthelasma may be an indication of abnormal lipid levels, it is equally important to realize that other metabolic disorders can lead to increased serum lipids, particularly diabetes and cirrhosis of the liver.4 There-fore, appropriate testing includes not only a serum lipid profile, but also a fasting plasma glucose and liver function tests (both of which are part of a comprehensive metabolic panel, or CMP, the single most common blood panel ordered by physicians).

Patients should be aware that, despite effective local treatment for xanthelasma, recurrences can and often do occur.

Although dietary modification and medications to reduce hyperlipidemia may be beneficial for other co-morbidities, there is no evidence that this form of therapy has any impact on the appearance or resolution of xanthelasma.5 [From what Megan and Nienna say, the ketogenic diet appears to reduce the appearance of xanthelasma, probably because it addresses the underlying issues that cause it]


Gladstone GJ, Myint S. Xanthelasma. In: Fraunfelder FT, Roy FH, eds. Current Ocular Therapy, 5th Edition. Philadelphia: W.B. Saunders, 2000. 452-3.
Ribera M, Pinto X, Argimon JM, et al. Lipid metabolism and apolipoprotein E phenotypes in patients with xanthelasma. Am J Med 1995; 99(5):485-90.
Bergman R. Xanthelasma palpebrarum and risk of atherosclerosis. Int J Dermatol 1998; 37(5):343-5.
Premalatha G, Mohan V. Xanthelasma palpebrum ­ a marker for hyperlipidemia in NIDDM patients? J Assoc Physicians India 1996; 44(1):73-4.
Dean FD. Xanthelasma and hyperlipoproteinaemia. Clinica Chimica Acta 1976; 66(2):189-93.

And

http://www.dailymail.co.uk/health/article-2038092/Yellow-eyelid-marks-xanthelasma-early-warning-sign-heart-disease.html

Yellow eyelid marks are 'early warning sign of heart disease'

By Claire Bates
UPDATED: 14:43 GMT, 16 September 2011

Yellow marking in the skin around the eyes can be a sign of heart disease, according to scientists.

A study of almost 13,000 people found people with the patches, known as xanthelasmata, were more likely have a heart attack or die within 10 years.

The spots are deposits of cholesterol which are soft and painless. They don't interfere with vision and people often get them treated at a dermatologist.

However, people with xanthelasma should go to their doctor as well, according to the research published online in the British Medical Journal.

The heart disease link was most acute in men aged between 70 and 79. Those with xanthelasmata were 12 per cent more at risk than others without the condition. The corresponding risk for women in this group was eight per cent.

However, the raised yellow patches around the eyelids was a more reliable sign of heart disease in women because of their lower overall risk.

Professor Anne Tybjaerg-Hansen, of the University of Copenhagen, said: 'The prevalence of xanthelasmata was similar in women and men.

'However, presence of xanthelasmata was a slightly better predictor of heart attack and heart disease in women than in men, and in those aged under 55 years compared with those aged 55 and over.

'This might be explained by the fact that male sex and age are both well known risk factors for heart attack and heart disease, so the presence of xanthelasmata just adds to this predetermined risk in men and in older people.

'In women, who have a smaller inherent risk of developing heart attack and heart disease, presence of xanthelasmata has a correspondingly larger predictive value.'

They said their results 'clearly establish for the first time that people with xanthelasmata have an increased risk of cardiovascular disease.'

The study also found white or grey rings around the cornea, known medically as arcus corneae, are not linked to an increased risk of heart disease.

Previous research has established that both xanthelasmata and arcus corneae are deposits of cholesterol. But about half of those who have either or both conditions will not test positively for high cholesterol in a blood test.

Prof Tybjaerg-Hansen’s team followed 12,745 individuals from 1976 until May 2009 who had all participated in the Copenhagen City Heart Study. They were aged between 20 and 93 and were free of heart disease when the project began.

In all age groups for both men and women, the risk of having a heart attack, developing heart disease or dying within a 10-year period increased in individuals with xanthelasmata.

This increased risk is independent of other well-known risk factors such as gender, smoking, obesity or high blood pressure and cholesterol levels.

The researchers said the presence of xanthelasmata could help clinicians when they diagnose heart disease and associated conditions.

And they said that their findings 'could be of particular value in societies where access to laboratory facilities and thus lipid profile measurement is difficult.'

It is interesting also that it appears under the eyes, it seems to me like the body is trying to get you to See that something is going on in the system that needs attention, a clear message of danger from your liver and/or heart.

 

[mcb]

I suspect that "it" can really represent problems of more than one origin, some of which could be benign, while others could be of concern. I have fairly large patches above my eyes, and have had them for decades, but I have no indicatons of liver disease.

My liver might be a bit old and sluggish, given what I have done to it over the years, but it still seems to work reasonably well, cranking out glucose and ketones on top of everything else now without a lot of fuss. Perhaps some people just have a minor genetic quirk that results in the patches, while other people have liver disease that also causes the patches.

For what it's worth, the photo of it that I saw in one of the links given above shows a much worse case of it than what I have.

 

[Timótheos]

In conclusion, we have demonstrated that moderate daily doses of vitamins C and E restore endothelial function in hyperlipidemic children. This effect was most likely mediated at the level of the vascular wall and in our short term study was not associated with changes in plasma biomarkers of oxidative stress, inflammation, or ADMA. Antioxidant vitamins C and E may improve endothelial function by increasing local NO bioavailability and may therefore retard the progression of atherosclerosis in high-risk children.

Thanks for the links and articles. I'll start taking these anti-oxidants again and was also considering a NO powder supplement called ProArgin-9 that my neighbour swears by.

I see now that what I thought was a mildly annoying dermatological issue could possibly be indicative of some larger problems based on diet and/or genetics. Being adopted, it is impossible to know for certain if hyperlipidemia runs in my bloodline, but having these show up at my age is probably not a good sign.

My diet has been within the paleo range for a couple years now, but I only managed to go into ketosis for about a month last fall. This is likely due to an excessive protein vs fat ratio, even with putting butter on my steaks and pork chops, it doesn't seem to be enough. I'll have to start eating way more broth! There's also xylitol several times a day in tea, the occasional piece of dark chocolate, 5% organic cranberry juice diluted in water and small amounts of carbs like rice or potatoes when eating out at a restaurant.

The best choice of action now seems to be a full on keto diet in order to activate the wild mtDNA, combined with regular resistance exercise for at least 6 weeks to see if it makes any difference. I wonder if this would actually reverse the appearance of the plaques or just hinder the development of more? I guess time will tell.

My doctor didn't seem to be too concerned about my overall blood test results, other than the elevated levels of LDL. But I was wondering, if I wanted further tests done to check the condition of my liver, what specific type of tests should I be requesting from him?

 

[Gaby]

My doctor didn't seem to be too concerned about my overall blood test results, other than the elevated levels of LDL. But I was wondering, if I wanted further tests done to check the condition of my liver, what specific type of tests should I be requesting from him?

While you go on ketosis, your vitamin C level needs will drop drastically, but I would try taking your max possible levels for awhile. Now it might be 8 or 10 grams, and it might drop to 2 or 4 with ketosis.

Vitamin C mega-dose pioneers claim that negative side effects of familial hypercholesterolemia were reverted with enough C intake. It has to do with the protective effect of Vitamin C on blood vessels, collagen, capillaries and the endothelium.

I remember coming across with specialized lab tests for the main mitochondrial functional pathways and liver detox pathways, but it would be probably best to find out with the lab. Some of these tests might be available only in main cities.