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Case Profile
A 45-year-old woman presents with orange lesions on both upper eyelids.
The patient has a prior history of multiple basal cell carcinomas. No other skin orange lesions or symptoms of hypercarotenemia. She denied that she had put on makeup on several occasions, taken any particular oral supplements, or had no special diet, especially one rich in fruits or vegetables.
Specialist examination: the skin on the inner side of the upper eyelid on both sides turned yellow, about 2 x 0.8 cm in size, and the middle of the lesion was the yellowest, about shallow near the edge of the lesion (Fig. 1).
Other tests: the patient's skin is phototype II and there are no symptoms of nevus basal cell syndrome. There were no suspicious basal cell carcinoma lesions, and the rest of the examination was normal.
Figure 1: Yellowing of both eyelids, from yellowish-orange to light orange. (Cited in References)
Q:
What is the most likely diagnosis?
A:
A. Xanthelasma
B. Liposis
C. Melasma
D.OPS
Answers in this issue
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Answers from the previous issue
Jump link: Cyclosporine for dermatomyositis, drug interactions need to be vigilant!
Carbamazepine and cyclosporine have adverse interactions. Cyclosporine soft is used in the treatment of dermatomyositis and works by inhibiting the proliferation and function of T cells. Carbamazepine is used to treat epilepsy. There is a clear drug interaction between carbamazepine and cyclosporine.
Due to the ability of carbamazepine to induce the activity of the CYP3A4 enzyme, this may lead to an acceleration of the metabolism of drugs metabolized by CYP3A4, such as cyclosporine, which reduces its plasma concentration. Decreased plasma concentrations of cyclosporine may weaken its pharmacological effects and affect the therapeutic effect of dermatomyositis.
Taking into account the effect of carbamazepine on the plasma concentration of cyclosporine, carbamazepine was replaced with an antiepileptic drug that had a smaller effect on the plasma concentration of cyclosporine, such as sodium valproate extended-release tablets.
参考文献：[1]Kluger N,Guillot B.Bilateral orange discoloration of the upper eyelids:a quiz. Acta Derm Venereol.2011 Mar; 91(2):211-2.doi:10.2340/00015555-0910.PMID:21384089.
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