A 74-year-old woman, normolipidemic, with a past medical history of osteoarthritis, fibromyalgia, and osteoporosis, presented with a >20-year history of eyelid pigmentation. Her treatment included lorazepam, paroxetine, amitriptyline, mirtazapine, hydroxychloroquine, prednisone, hidroferol, denosumab, and enalapril. Physical examination revealed yellow–orange spots on the upper eyelids (Fig. 1), and dermoscopy showed fluorescent yellow pigmentation (Fig. 2). A probable diagnosis of yellow–orange eyelid spots (YOES) was established, without the need for additional tests or treatment.
YOES, first described in 2008 by Assouly et al. as “orange palpebral spots,” are a rare benign entity characterized by nonpalpable yellow–orange pigmentation in the medial region of the upper eyelids. Although their etiology remains uncertain, several theories have been proposed, including the accumulation of carotenoids and lipofuscin, chronic rubbing of the eyelids, or the use of serotonin reuptake inhibitors (SRIs). Of note, the patient was on multiple antidepressants, including SRIs.
Differential diagnosis includes xanthelasma or xanthoma, which are palpable and associated with hyperlipidemia in 50% of cases; necrobiotic xanthogranuloma, frequently linked to monoclonal gammopathy; fluorescein staining; carotenoderma; and exogenous pigmentations such as makeup. However, pigment distribution, clinical characteristics, and medical history are usually sufficient to distinguish YOES from other conditions, thereby avoiding misdiagnosis and unnecessary procedures.
