What Are Cholesterol Bumps?

Cholesterol bumps scientifically called cutaneous xanthomas,¹ are yellowish bumps that contain fat deposits (such as cholesterol) and associated inflammation. The appearance of xanthomas may indicate an underlying health condition, such as high cholesterol or a cholesterol imbalance — though they may also appear idiopathically, i.e., without a known cause.

What are cholesterol bumps?

Cholesterol bumps are benign but often indicate an underlying health concern. They commonly occur on the eyelids, elbows, joints, knees, hands, and feet. When xanthomas develop on the eyelids, they are called xanthelasma palpebrarum.² 

What do they look like?

Xanthomas are waxy yellowish-orange bumps that have defined edges. These bumps can vary in size. Often, they are relatively small, but they can sometimes be larger than three inches, depending on their type.

What do they feel like?

Cholesterol bumps are usually painless. They can sometimes cause discomfort if they are large or block the movement of the eyelids. 

Causes

Xanthomas may be a sign of an underlying medical condition in which the levels of lipids in the body are imbalanced or raised. These associated lipid conditions may be genetic or a result of lifestyle factors. 

Genetic factors 

Some causes of cholesterol bumps can be inherited. The following conditions are examples of these: 

• Familial lipoprotein lipase deficiency. Lipoprotein lipase is an enzyme that lowers triglyceride levels in the body. An inherited deficiency in this protein can result in an increase in lipids, potentially causing lipid-filled bumps to appear on the skin.

• Familial hypertriglyceridemia. Familial hypertriglyceridemia is a genetic condition in which people have a higher amount of triglycerides circulating in their blood. Triglycerides are a type of lipid, and increased triglycerides can cause xanthomas.

• Familial dysbetalipoproteinemia. Dysbetalipoproteinemia is a condition in which people have increased lipids in their blood due to an inherited genetic cause. This may result in the formation of xanthomas.

Lifestyle factors 

Some existing conditions and lifestyle factors can increase the risk of developing an imbalance of lipids in the body, potentially causing cholesterol bumps. Some factors that can influence the levels of lipids in the body include: 

• Obesity

• Diabetes

• Smoking

• Primary biliary cholangitis

• Kidney disorders

• Hypothyroidism

• Pancreatitis

• Liver disease

• Excessive alcohol consumption

• Some medications (ciclosporin, tamoxifen, estrogens, oral retinoids, prednisone)

Symptoms 

As cholesterol bumps, or xanthomas, are usually painless, the symptoms tend to be only visual. The main symptom of a cholesterol bump is the appearance of a waxy, yellowish bump on the skin.

Cholesterol bumps may increase in size over time. They may appear as a single bump or in clusters. 

Xanthomas tend to only cause discomfort if they are large or block the movement of the eyelids. They may also appear on the elbows, joints, hands, and feet. In these places, they may cause discomfort if they are large or hinder daily movements, such as rubbing the bumps against shoes or knocking them when using your hands. 

Prevention 

Can you avoid developing these bumps? 

The best way to try and prevent developing cholesterol bumps is to watch the lipid levels in your body. To do this, you should have regular lipid profiles done with a doctor. Healthy adults should have a lipid profile every four to six years.³ 

If you have any genetic conditions or lifestyle factors that may cause a lipid imbalance, you should have a lipid profile done more regularly. If this applies to you, ask your doctor how often it is recommended for you to get your lipids checked. 

To maintain a healthy balance of lipids in your body, it is important to live a healthy lifestyle. This includes regular exercise, maintaining a healthy weight, and eating a diet rich in fiber and unsaturated fats, with fewer sugars and saturated fats. 

Diagnosis 

A doctor can diagnose xanthoma by simply looking at them. They may also order a lipid profile to check if the xanthoma is caused by a lipid imbalance. 

A lipid profile is done via a simple blood test. The blood is then tested for total cholesterol, HDL, LDL cholesterol, and triglyceride levels. From these results, the doctor can determine if your lipid levels are normal or if they may be causing the xanthoma. 

A skin biopsy may also be done to confirm the diagnosis. Additionally, thyroid, liver, and kidney function tests, fasting glucose tests, or other tests may be run to check for underlying causes of the xanthoma.

Furthermore, due to the association of diffuse xanthomas in normolipidemic patients with hematologic disease, your doctor may order further blood testing and urine testing to rule out blood diseases.

Treatment 

Can you pop them? 

It is not advised to pop cholesterol bumps. This is likely to lead to pain, bleeding, and scarring of the cholesterol bumps. It may also make them more open to infection if you puncture the skin.

How can you get them removed? 

As cholesterol bumps are benign, they do not need to be removed for medical reasons. However, you may choose to get them removed for cosmetic reasons. There are a number of removal methods you may want to try: 

• Cryotherapy. Cryotherapy involves freezing the cholesterol bumps with liquid nitrogen or another chemical.

• Laser. CO2 is a common laser removal method for cholesterol bumps, as well as other skin blemishes. A laser made of carbon dioxide removes layers of damaged skin.

• Surgery. The xanthomas can be cut out using simple surgery.

• Topical trichloroacetic acid. Trichloroacetic acid can be applied to the xanthomas. Depending on the size of the xanthoma, it may disappear with one month of trichloroacetic acid treatment. 

• Electrodesiccation. Electrodesiccation is a technique in which an electrical current removes blemishes on the skin, including cholesterol bumps.

• Medication. Xanthomas may be cleared from the skin by treatment with anti-cholesterol medications if your xanthomas are caused by high cholesterol levels.

The importance of managing your cholesterol 

As xanthomas are typically caused by an imbalance of lipids in the body, changes to cholesterol levels can result in the appearance of xanthomas. Xanthomas can indicate underlying health concerns, such as high cholesterol. 

High cholesterol can also have more severe effects than the appearance of xanthomas. High levels of ‘bad’ cholesterol (LDL cholesterol) can cause a buildup of plaque in your arteries, increasing the risk of cardiovascular disease, stroke, or heart attack. 

When to see a doctor 

It is important to visit your doctor when you notice that xanthomas have appeared on your skin. This is because they may indicate an underlying health concern. It is best to find the underlying health issue as soon as you can to have the best chance of restoring your health.

The lowdown 

Cholesterol bumps, or xanthomas, are benign, yellow bumps filled with lipids that may appear on the eyelids, joints, elbows, hands, and feet. They often indicate an underlying health issue in which lipids are imbalanced in the body, such as high cholesterol. 

It is important to get these checked when you notice them identify any underlying health concerns.