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By Kirkland Lau, DO, and Stephen M. Schleicher, MD
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CASE:
A 39-year-old man presents to your emergency department with bilateral fusiform plaques along the superior medial aspects of the periorbital region. He states that he first noticed these lesions two years ago and that they have been slowly spreading ever since. For cosmetic reasons, he would like them removed, although they are asymptomatic. He denies a family history of similar lesions, and his medical history is significant only for mild hypercholesterolemia.
WHAT IS YOUR DIAGNOSIS? |
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This patient has xanthelasma palpebrarum, a condition caused by the accumulation of lipids such as cholesterol and triglycerides under the skin. It is most common in middle-aged individuals and is associated with hypercholesterolemia or other hepatic disorders in up to half of those affected. Xanthelasma appears as oval, yellow-orange plaques up to 3 cm in diameter; typically, they occur in a bilateral distribution around the medial canthus of the eyes. They can be removed by surgical excision, topical application of trichloroacetic acid, or laser ablation. |
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Dr. Lau is an associate with a division of DermDx Centers for Dermatology in Sinking Spring, Pennsylvania. Dr. Schleicher is director of DermDx Centers and a clinical instructor of dermatology at the Philadelphia College of Osteopathic Medicine, at Kings College in Wilkes-Barre, Pennsylvania, and at Arcadia University in Glenside, Pennsylvania. He is also a member of the EMERGENCY MEDICINE editorial board.
Emerg Med 40(9):43-44, 2008
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