High cholesterol is a fairly common condition in which too much cholesterol is circulating in your blood. Cholesterol is a lipid (fat) that can build up into plaques in your arteries, narrowing them and constricting blood flow to and from your heart. This can lead to heart disease, heart attack, or stroke.

High cholesterol doesn’t usually cause symptoms unless it leads to a complication. This means that you often don’t know you have high cholesterol until a doctor tests your blood for it.

But high levels of circulating fats (cholesterol and triglycerides) can sometimes lead to noticeable skin changes. The first clue that you have high cholesterol may come in an unexplained set of bumps, patches of soft yellowish skin, or discoloration on your extremities.

These skin symptoms may be an important sign that you need to manage your cholesterol levels.

Here’s a rundown of how uncontrolled high cholesterol, including familial hypercholesterolemia, can affect your skin and what to do about it.

Cholesterol: How high is too high?

A lipid panel can measure the total amount of cholesterol in your blood.

  • Below 200 mg/dL is the optimal level.
  • Between 200 and 240 mg/dL suggests borderline high cholesterol.
  • Levels at 240 mg/dL or higher indicate high cholesterol.

As of 2022, more than 94 million Americans over the age of 20 had borderline high or high cholesterol. Experts suspect many more have it but aren’t diagnosed.

When too much cholesterol circulates in your bloodstream, it can collect in fatty deposits under the skin. This can cause a rash of orangish or yellowish bumps filled with fat.

Cholesterol can also block tiny blood vessels called capillaries that supply oxygen to the skin. This can cause the surface of your skin to change color. It may also contribute to skin conditions such as psoriasis.

High cholesterol can sometimes lead to a more serious condition called cholesterol embolism. That’s when a crystal of cholesterol plaque breaks off and blocks a vein or artery. This can lead to skin ulcers or other complications.

The first step to addressing a cholesterol-related skin problem is identifying the condition. You can then treat the underlying causes, including managing your cholesterol and triglyceride levels.

Skin conditions caused by high levels of cholesterol and triglycerides range from mild to more severe. Here are a few of the most common.

Xanthoma

Xanthomas are localized fat (lipid) deposits that typically affect the skin, tissues underneath the skin, and tendons. There are a few categories of xanthoma:

  • Eruptive xanthoma: the sudden appearance of what appears to be a rash of several bumps on your skin, filled with fatty deposits of cholesterol
  • Tuberous or tendinous xanthomas: nodules often found on the knuckles, knees, elbows, and buttocks
  • Verrucous xanthomas: wart-like xanthomas in the inside lining of your mouth or sometimes on the genitals
  • Planar xanthomas: flat or slightly elevated patches at any part of the body

Xanthelasma

Xanthelasma is the most common type of planar xanthoma. It is a soft patch of yellowish bumps around your eyes, usually around the corners of your eyes closest to your nose. It’s more common on the upper lid than the lower lid, but it can affect both.

Psoriasis

Psoriasis is an inflammatory skin condition that causes raised, red, itchy patches of skin due to unusually fast turnover of skin cells. It’s a chronic autoimmune disorder that causes an inflammatory response in your body. It can affect your blood vessels, causing a higher risk of heart disease.

According to 2017 research, there’s also a link between psoriasis and high cholesterol levels. Researchers aren’t yet sure why that is. If you have psoriasis, you may want to consider having your cholesterol and triglyceride levels checked.

Cholesterol embolism

A cholesterol embolism occurs when crystals made up of cholesterols and other substances break free from plaques in one of your large arteries. They then travel through your circulatory system before becoming lodged in a smaller artery or blood vessel.

This can block the flow of blood to that area, causing damage and skin symptoms such as:

  • leg ulcers
  • skin discoloration
  • gangrene
  • blue or purple toes
  • livedo reticularis

Livedo reticularis

Livedo reticularis is a bluish-red mottling of the skin in a netlike pattern. It usually shows up on the thighs, feet, toes, buttocks, lower legs, or other extremities. Many things can cause the pattern, including cholesterol embolism.

Contact a doctor if it doesn’t go away on its own and parts of your skin turn very dusky blue to black. You may have a blockage that needs urgent medical attention.

Your eyes may also be trying to tell you something

If you are younger than 45 and have noticed a ring around your iris that wasn’t there before, you may be developing corneal arcus.

It’s a light-colored ring made up of gray, yellow, or white deposits at the outer edge of your cornea. It’s common after middle age, but if you develop it before age 45, it might be a sign of high cholesterol or familial hypercholesterolemia.

High cholesterol can lead to several life threatening conditions, including heart disease and stroke. It’s a good idea to make an appointment with a healthcare professional to check your cholesterol levels early and often.

The Centers for Disease Control and Prevention (CDC) recommends cholesterol testing starting at age 20 and every 5 years after for people at low risk for cardiovascular disease. People with cardiovascular disease or its risk factors should test for cholesterol more often.

The key to treating your skin condition is to find and address the underlying cause. Your healthcare team can help identify your condition, alert you of potential risks, and recommend ways to manage your symptoms.

If your skin condition is due to high cholesterol, your healthcare team will recommend lifestyle changes such as:

They may also recommend cholesterol-lowering medications if needed.

The American Heart Association recommends several key ways to lower or prevent high cholesterol:

High cholesterol is a common condition affecting millions of people, some of whom don’t know they have it.

When you have too much cholesterol and other fat circulating in your blood, it can build up in your arteries. This can lead to life threatening conditions like heart disease, heart attack, and stroke. It can also lead to a host of skin conditions.

If you notice fatty deposits under your skin, yellowish bumps, patches around your eyes, or mild to severe skin discoloration, you might have a skin condition related to high cholesterol.

It’s important to work with your healthcare team to check and manage your cholesterol levels. If high cholesterol is causing your skin condition, your doctor can recommend medication or lifestyle changes to help lower your cholesterol level and help you and your skin stay healthy.