Are yellow skin deposits (xanthomas) a sign of cholesterol disorders? 

Yellow skin deposits, medically known as xanthomas, are a significant clinical sign of underlying cholesterol disorders. These deposits occur when excess fats, particularly Low-Density Lipoprotein (LDL) cholesterol, leak out of the bloodstream and accumulate in the skin, tendons, or around the eyes. While they are not harmful themselves, they are often a ‘red flag’ for exceptionally high cholesterol levels that may be caused by genetic conditions like Familial Hypercholesterolaemia (FH). 

In the UK, most people with high cholesterol have no symptoms at all. However, for a small percentage of the population, the body begins to store excess fat in visible ways. When a healthcare professional identifies a xanthoma during a physical examination, it changes the clinical approach from a routine check to a high-priority investigation. These deposits are considered a direct window into a person’s metabolic health and cardiovascular risk. 

What We will cover in this Article 

• The biological reason why cholesterol deposits form under the skin. 

• Different types of xanthomas, including xanthelasma and tendon xanthomas. 

• The strong link between these physical signs and inherited genetic disorders. 

• Why noticing these deposits requires an urgent lipid profile blood test. 

• How the NHS manages patients who present with these visible markers. 

• Treatment options to reduce the appearance of xanthomas and lower internal risk. 

Why do cholesterol deposits form in the skin? 

Xanthomas form when the concentration of lipids in the blood becomes so high that the body can no longer keep them contained within the vascular system. The excess cholesterol is taken up by specialised white blood cells called macrophages, which then migrate into the skin or tendons, creating the characteristic yellowish or orange-toned bumps. 

According to the British Heart Foundation (2025), these deposits are most commonly associated with a ‘Type II’ lipid profile, characterised by extremely high LDL levels. Because the fats are being physically deposited into the tissues, it indicates that the arteries are likely experiencing a similar, silent build-up of plaque. Therefore, xanthomas are considered a major ‘warning light’ for advanced atherosclerosis. 

Common types of yellow skin deposits 

There are several different ways these deposits can appear on the body, each providing a clue about the specific type of lipid disorder involved. 

• Xanthelasma: The most common form, appearing as flat or slightly raised yellow patches on the eyelids. While they can occur in people with normal cholesterol, they are frequently a sign of high lipids in younger adults. 

• Tendon Xanthomas: These are hard, painless lumps that develop over tendons, most commonly the Achilles tendon at the back of the heel or the knuckles of the fingers. These are almost always a sign of a genetic condition. 

• Eruptive Xanthomas: These appear suddenly as crops of small, itchy, yellow-red bumps, usually on the buttocks, shoulders, or limbs. These are often a sign of severely high triglycerides. 

• Tuberous Xanthomas: Larger, firm, yellow-orange nodules typically found on the elbows or knees. 

The genetic connection: Familial Hypercholesterolaemia 

In a UK clinical setting, the presence of tendon xanthomas is a key diagnostic criterion for Familial Hypercholesterolaemia (FH). This is a hereditary condition where the liver cannot clear LDL cholesterol from the birth. Because the levels are so high for so long, the body begins to store the excess in the tendons. 

The NICE Guideline [NG238] (2024) states that any adult or child with tendon xanthomas should be fast-tracked for genetic testing and a specialist lipid review. Identifying these deposits early can be lifesaving, as it allows for the diagnosis of FH before a heart attack or stroke occurs. If you notice these hard lumps on your knuckles or heels, it is essential to mention them to your GP specifically. 

Deposit Type	Common Location	Likely Lipid Trigger
Xanthelasma	Eyelids	High LDL or normal lipids.
Tendon Xanthoma	Knuckles / Achilles	Very high LDL (Genetic FH).
Eruptive Xanthoma	Buttocks / Limbs	Very high Triglycerides.
Corneal Arcus	Edge of the Iris	High LDL (in those under 45).

Treatment and management 

Treating xanthomas focuses primarily on addressing the internal cause; the high cholesterol or triglycerides. Once the blood lipid levels are brought under control through high-intensity statins or other medications, many xanthomas will naturally begin to shrink or soften over several months, although they may not disappear entirely. 

For deposits that are aesthetically concerning, such as xanthelasma on the eyelids, specialist treatments like laser therapy, chemical peels, or surgical removal may be considered. However, the NHS prioritises the cardiovascular risk management first. According to UK clinical standards, the disappearance of a xanthoma is often used as a visual indicator that the medical treatment is successfully lowering the patient’s internal risk. 

To Summarise 

Yellow skin deposits or xanthomas are a clear physical sign of an underlying cholesterol or triglyceride disorder. While they are often associated with genetic conditions like Familial Hypercholesterolaemia, they can also appear due to poorly controlled diabetes or lifestyle-related high lipids. In the UK, the discovery of these deposits should always lead to a comprehensive blood test and a cardiovascular risk assessment. 

If you experience severe, sudden, or worsening symptoms, such as sudden chest pain, shortness of breath, or weakness in your face or arms, call 999 immediately. 

You may find our free BMI Calculator helpful for monitoring weight-related lipid risks as part of your overall health assessment. 

Authority Snapshot (E-E-A-T Block) 

This article was reviewed by Dr. Rebecca Fernandez to ensure clinical accuracy and safety. Dr. Fernandez is a UK-trained physician with an MBBS and extensive experience in cardiology, internal medicine, and emergency medicine. This guide provides evidence-based information on physical markers of lipid disorders to support early diagnosis and proactive heart health management.