QWhat are Orange Palpebral Spots?

There are many periorbital rashes and single lesions that dermatologists need to be aware of. Usually when a dermatologist sees yellowish plaques or papules in a periocular distribution, a diagnosis of xanthelasma is suspected. However a patient may present with a similar presentation with an important difference, the periorbital lesions are orange or orange/yellow-tinged. In this case, the diagnosis is Orange Palpebral Spots (OPS) which can sometimes be mistaken or misdiagnosed as xanthelasma.

Orange palpebral spots are flat, orange-pigmented ovoid macules/patches that are most commonly found on the medial superior eyelids. First reported in 2008, these spots are most commonly described in light-skinned, middle-aged woman. On histopathology, OPS often present as high-situated adipose cells  in  the  reticular  dermis  and  brown microgranules in the superficial dermis, along with  occasional  lipofuscin  pigment-laden  fat  cells¹. Of note there are no lipid-laden macrophages (also known as “foam cells”) and no inflammatory infiltrate. Positive Fontana-Masson staining has been reported. The etiology is unknown and there are no known associations with systemic disease. One review found that most of the patients studied confirmed that their diet was particularly rich in fruit and/or vegetables².

OPS are a benign entity, and it is important to be aware of this diagnosis to provide reassurance to the patient and to avoid an unnecessary workup.

References:

1. Hackley M, Brownstone N, Sun C, Hsu S. Orange palpebral spots on bilateral upper eyelids. Dermatol Online J. 2024;30(4). doi:10.5070/D330464121
2. Assouly P, Cavelier-Balloy B, Dupré T. Orange Palpebral Spots. Dermatology. 2008;216(2):166-170. doi:10.1159/000111516