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Malekzadeh H, Ormseth B, Janis JE. A Practical Review of the Management of Xanthelasma palpebrarum. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4982. [PMID: 37235133 PMCID: PMC10208694 DOI: 10.1097/gox.0000000000004982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/17/2023] [Indexed: 05/28/2023]
Abstract
Xanthelasma palpebrarum is the most common type of xanthomatous lesion. Various methods for treating Xanthelasma palpebrarum have been reported. We conducted a systematic review to evaluate the efficacy and associated complications of different treatment methods, and we summarized these findings as a practical review designed to be clinically useful, accessible, and impactful. Methods The PubMed and Embase databases were searched to identify clinical studies that reported on outcomes and complications of different methods of Xanthelasma treatment. The electronic databases were searched from January 1990 to October 2022. Data on study characteristics, lesion clearance, complications, and recurrences were collected. Results Forty-nine articles (including 1329 patients) were reviewed. The studies reported on surgical excision, laser modalities, electrosurgical techniques, chemical peeling, cryotherapy, and intralesional injection. The majority of studies were retrospective (69%) and single-arm (84%). Surgical excision combined with blepharoplasty and skin grafts showed excellent outcomes for large Xanthelasma. CO2 and erbium yttrium aluminum garnet (Er:YAG) were the most commonly studied lasers and showed more than 75% improvement in over 90% and 80% of patients, respectively. Comparative studies reported better efficacy for CO2 laser than both Er:YAG laser and 30%-50% trichloroacetic acid. Dyspigmentation was the most encountered complication. Conclusions Different methods for the treatment of Xanthelasma palpebrarum have been reported in the literature, with moderate to excellent efficacy and safety profiles depending on the size and location of the lesion. Surgery is more appropriate for larger and deeper lesions, whereas laser and electrosurgical techniques can be used in smaller and more superficial contexts. Only a limited number of comparative studies have been conducted, and novel clinical trials are necessary to further augment appropriate treatment selection.
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Affiliation(s)
- Hamid Malekzadeh
- From the Department of Plastic Surgery, University of Pittsburgh, Pittsburgh, Pa
| | - Benjamin Ormseth
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Abstract
Xanthelasmas are localized accumulation of lipid deposits on the eyelids. Lesions are typically asymptomatic and treatment is often sought for cosmetic purposes. Unfortunately, there is paucity of strong evidence in the literature for the effective treatment of normolipidemic xanthelasmas. A literature search using the term “xanthelasma” was carried out in PubMed and Medline databases. Only articles related to treatment were considered and analyzed for their data. Commonly cited treatments include topical trichloroacetic acid, liquid nitrogen cryotherapy, and various lasers including carbon dioxide, Er:YAG, Q-switched Nd:YAG, and pulse dye laser. However, traditional surgical excision has also been used. This article reviews these currently accepted modalities of treatment.
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Affiliation(s)
- Zainab Laftah
- King's College Hospital, Dermatology department, Denmark Hill, London SE5 9RS, UK
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Heng JK, Chua SH, Goh CL, Cheng S, Tan V, Tan WP. Treatment of xanthelasma palpebrarum with a 1064-nm, Q-switched Nd:YAG laser. J Am Acad Dermatol 2017; 77:728-734. [PMID: 28666611 DOI: 10.1016/j.jaad.2017.03.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 03/19/2017] [Accepted: 03/26/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Xanthelasma palpebrarum is the most common cutaneous xanthoma characterized by soft, yellow papules or plaques that arise on the periorbital skin. As these lesions can be cosmetically disfiguring, many patients seek medical help to remove these lesions. OBJECTIVE To determine the effectiveness and minimum number of treatment sessions with a 1064-nm, Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of xanthelasma. METHODS A retrospective review of patients with xanthelasma consecutively treated with Q-switched Nd:YAG laser was conducted. Forty-six patients with 103 lesions were identified from January 2012 through August 2015. Photographs taken of patients immediately before treatment and 4-8 weeks after treatment were independently evaluated by 2 dermatologists. RESULTS After a single treatment session, 93.2% of lesions had some degree of clearance. All lesions had excellent-to-complete clearance after at least 4 treatment sessions. Patients usually required 4 treatment sessions for optimal results. LIMITATIONS This was a retrospective study. Treatment parameters varied, follow-up periods were not uniform, and response was not assessed with a validated scale. CONCLUSION The Q-switched Nd:YAG laser is effective and well tolerated in the treatment of xanthelasma in our study population.
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Nguyen AH, Vaudreuil AM, Huerter CJ. Systematic review of laser therapy in xanthelasma palpebrarum. Int J Dermatol 2017; 56:e47-e55. [DOI: 10.1111/ijd.13534] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 10/24/2016] [Accepted: 11/14/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Austin H. Nguyen
- Division of Dermatology; Creighton University School of Medicine; Omaha NE USA
| | - Adam M. Vaudreuil
- Division of Dermatology; Creighton University School of Medicine; Omaha NE USA
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Continuous Wave Potassium Titanyl Phosphate Laser Treatment is Safe and Effective for Xanthelasma Palpebrarum. Dermatol Surg 2016; 42:860-6. [PMID: 27227474 DOI: 10.1097/dss.0000000000000772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although not an accepted standard treatment, the 532-nm continuous wave potassium titanyl phosphate (CW-KTP) laser might be a powerful device to treat xanthelasma palpebrarum (XP). OBJECTIVE To determine the safety and efficacy of CW-KTP laser treatment for XP. MATERIALS AND METHODS Between January 2013 and January 2015, 30 consecutive patients with XP were treated with a 532-nm CW-KTP laser (spot size: 0.9 mm, power: 5.0 W, fluence: 36-38 J/cm, pulse width: 46 milliseconds, frequency: 2.0 Hz, passes per session: 3). In a retrospective study design, safety and efficacy data were collected and analyzed. RESULTS Overall, 29/30 (97%) of patients had an excellent cosmetical result. Downtime was 1 week with crusted lesions. Although slight hypopigmentation was common, only 1/30 (3%) patients had hypopigmentation that was more than expected. Recurrences (13/30; 43%) were frequent, so that yearly maintenance therapy was warranted. No major side effects were noticed. CONCLUSION Continuous wave KTP laser therapy is safe and highly effective for XP, although regular follow-up treatments are often necessary to maintain the achieved cosmetic results.
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Mourad B, Elgarhy LH, Ellakkawy HA, Elmahdy N. Assessment of efficacy and tolerability of different concentrations of trichloroacetic acid vs
. carbon dioxide laser in treatment of xanthelasma palpebrarum. J Cosmet Dermatol 2015; 14:209-15. [DOI: 10.1111/jocd.12148] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Basma Mourad
- Department of Dermatology & Venereology; Faculty of medicine; Tanta University; Tanta Egypt
| | - Lamia H. Elgarhy
- Department of Dermatology & Venereology; Faculty of medicine; Tanta University; Tanta Egypt
| | - Heba-Alla Ellakkawy
- Department of Dermatology & Venereology; Faculty of medicine; Tanta University; Tanta Egypt
| | - Nageh Elmahdy
- Department of Pharmacology & Toxicology; Faculty of Pharmacy; Tanta University; Tanta Egypt
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Abdelkader M, Alashry SE. Argon laser versus erbium:YAG laser in the treatment of xanthelasma palpebrarum. Saudi J Ophthalmol 2015; 29:116-20. [PMID: 25892929 PMCID: PMC4398792 DOI: 10.1016/j.sjopt.2014.09.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 07/22/2014] [Accepted: 09/17/2014] [Indexed: 11/19/2022] Open
Abstract
Background Xanthelasma palpebrarum is the most common of the xanthomas with asymptomatic, symmetrical, bilateral, soft, yellow, polygonal papules around the eyelids. Though it is a benign lesion causing no functional disturbance, it is esthetically annoying. The surgical laser offers an extremely elegant and powerful solution to this problem. Objective To evaluate the effectiveness of erbium:YAG and argon lasers in the treatment of xanthelasma lesions. Patients and methods Forty patients were included in the study. Twenty patients (15 patients were bilateral with 30 eyes either in the upper or lower lid and 5 patients were unilateral) were treated with erbium:YAG laser. Another 20 patients (10 patients were bilateral with 20 eyes and 10 patients were unilateral) were treated with argon laser. Results In the majority of treated patients (either treated with erbium:YAG or argon laser), xanthelasma lesions were completely disappeared or significantly decreased in size. Two patients showed pigmentary changes in the form of hypopigmentation with erbium:YAG laser (one case), another case showed hyperpigmentation. No intraoperative complication was observed. No significant scar or recurrence was observed. Conclusion Argon laser in xanthelasma is an easy, effective, and safe method of treatment for small lesions and YAG laser is more better for large lesions than argon laser.
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Affiliation(s)
- Mona Abdelkader
- Department of Ophthalmology (Mansoura Ophthalmic Center), Mansoura University, Egypt
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Goel K, Sardana K, Garg VK. A prospective study comparing ultrapulse CO2
laser and trichloroacetic acid in treatment of Xanthelasma palpebrarum. J Cosmet Dermatol 2015; 14:130-9. [DOI: 10.1111/jocd.12137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Khushbu Goel
- Department of Dermatology, Venereology and Leprology; Maulana Azad Medical College & Associated Lok Nayak Hospital; New Delhi India
| | - Kabir Sardana
- Department of Dermatology, Venereology and Leprology; Maulana Azad Medical College & Associated Lok Nayak Hospital; New Delhi India
| | - Vijay Kumar Garg
- Department of Dermatology, Venereology and Leprology; Maulana Azad Medical College & Associated Lok Nayak Hospital; New Delhi India
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Fractional CO2 Laser Is an Effective Therapeutic Modality for Xanthelasma Palpebrarum. Dermatol Surg 2014; 40:1349-55. [DOI: 10.1097/dss.0000000000000172] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Delgado Navarro C, Lanuza García A, Llorca Cardeñosa A, Bañón-Navarro R, Corchero Martin G. Aplicación de láser CO2 para el tratamiento de xantelasmas palpebrales. ARCHIVOS DE LA SOCIEDAD ESPAÑOLA DE OFTALMOLOGÍA 2013; 88:320-2. [PMID: 23886365 DOI: 10.1016/j.oftal.2011.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Revised: 12/01/2011] [Accepted: 12/23/2011] [Indexed: 10/28/2022]
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Abstract
The carbon dioxide (CO(2)) laser is a versatile tool that has applications in ablative lasing and caters to the needs of routine dermatological practice as well as the aesthetic, cosmetic and rejuvenation segments. This article details the basics of the laser physics as applicable to the CO(2) laser and offers guidelines for use in many of the above indications.
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Affiliation(s)
- Ds Krupa Shankar
- Professor and Head, Department of Dermatology, Manipal Hospital, Bangalore, Karnataka, India
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12
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Cannon PS, Ajit R, Leatherbarrow B. Efficacy of trichloroacetic acid (95%) in the management of xanthelasma palpebrarum. Clin Exp Dermatol 2010; 35:845-8. [DOI: 10.1111/j.1365-2230.2010.03818.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Elabjer BK, Busić M, Sekelj S, Krstonijević EK. Operative treatment of large periocular xanthelasma. Orbit 2009; 28:16-9. [PMID: 19229739 DOI: 10.1080/01676830802418872] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To present our experience in operative treatment of large periocular xanthelasma. METHODS Sixty-three patients with large periocular xanthelasma were operatively treated in our department. Ipsilateral and/or contralateral lid skin grafts harvested by blepharoplasty, alone or in combination with local flaps, were used. Forty patients (64%) had enough skin to graft the defect after primary xanthelasma removal. In 10 patients, additional local flaps were used: modified rhomboid flap in six patients, local advancement flap in two, and bi-lobed flap in two patients. In three patients (5%), a sequential approach was applied since xanthelasma were too large to be completely removed in a single-step excision. No serious complications were shown. RESULTS Patients were followed from 6 months to 8 years. Five patients (8%) returned with recurrences 3-8 years after primary excision. CONCLUSIONS In lack of the setting for xanthelasma laser treatment, operative approach of a single-step or sequential excision using lid skin graft combined with local flaps proved its value for large periocular xanthelasma.
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Abstract
Xanthelasma is a common disfiguring condition, which can be difficult to treat. Various treatments have been reported previously with varying degree of success. We report a simple yet effective technique of excision of the lesions with excellent cosmetic outcome.
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Affiliation(s)
- Yajati K Ghosh
- Department of Ophthalmology, University Hospital, Clifford Bridge Road, Coventry CV2 2DX, UK.
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Fusade T. Treatment of xanthelasma palpebrarum by 1064-nm Q-switched Nd:YAG laser: a study of 11 cases. Br J Dermatol 2007; 158:84-7. [DOI: 10.1111/j.1365-2133.2007.08194.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
BACKGROUND AND OBJECTIVE Xanthelasma palpebrarum presents a therapeutic and aesthetic challenge because of its high visibility and frequent rate of recurrence with a wide variety of treatments. Many patients are disappointed by an initial unsuccessful treatment and fail to return for further therapy until the skin problem has become quite conspicuous. A simple treatment with few side effects and good acceptance remains an important goal. STUDY DESIGN/MATERIALS AND METHODS Fifteen patients with a total of 33 xanthelasma lesions, were treated by an erbium:YAG laser. The follow-up period of observation was between seven and twelve months. RESULTS All lesions were removed without hyperpigmentation or scarring. CONCLUSIONS The erbium:YAG laser represents an effective means for treating xanthelasmas with few side effects.
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Affiliation(s)
- C Borelli
- Department of Dermatology, Ludwig-Maximilians-University, 80337-Munich, Germany.
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Mannino G, Papale A, De Bella F, Mollo R, Morgia P, Gabrieli CB. Use of Erbium:YAG Laser in the Treatment of Palpebral Xanthelasmas. Ophthalmic Surg Lasers Imaging Retina 2001. [DOI: 10.3928/1542-8877-20010301-08] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND AND OBJECTIVE Due to its delicate location near the eye and the high recurrence rate, the therapy of xanthelasma palpebrarum is a difficult surgical task. Besides chemical, physical, and surgical procedures, various laser systems have been used to treat these lesions (argon laser, pulsed dye laser, and CO2 laser). This study was designed to critically evaluate the use of the ultrapulsed CO2 laser for the treatment of xanthelasma palpebrarum. STUDY DESIGN/MATERIALS AND METHODS We report about the standardized treatment of 23 patients (52 periorbital xanthelasmas) and the results obtained after one treatment with a new generation, ultrapulsed CO2 laser (COHERENT Ultrapulse 5000C, Palo Alto, CA; 250-500 mJ; 600-900 microsec; 10,600 nm). The followup time was 10 months. RESULTS All lesions could be removed completely with a single laser treatment. As for side effects, only transient pigmental changes (4% hyperpigmentations, 13% hypopigmentations) and no visible scarring was observed. Three patients (13%) developed a recurrence of xanthelasma. CONCLUSIONS The ultrapulsed CO2 laser is an effective and safe therapeutic alternative to the hitherto described approaches.
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Affiliation(s)
- C Raulin
- Center for Dermatologic Laser Therapy, Karlsruhe, Germany.
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Sampath R, Parmar D, Cree IA, Collin JR. Histology of xanthelasma lesion treated by argon laser photocoagulation. Eye (Lond) 1998; 12 ( Pt 3a):479-80. [PMID: 9775255 DOI: 10.1038/eye.1998.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Abstract
BACKGROUND Although many treatment modalities have been described for xanthelasma palpebrarum, no single technique has emerged as dominant. OBJECTIVES Our purpose was to review the various therapeutic modalities for xanthelasma and to assess the efficacy of topical bichloracetic acid. METHODS Thirteen patients with 25 xanthelasma were treated with topical 100% bichloracetic acid. Efficacy was assessed over a follow-up period of 7 months to 10.5 years (average, 64 months). RESULTS Eighty-five percent of patients experienced initial complete clearing, and 72% of their lesions have not required retreatment over an average period of 68 months. Recurrences responded well to repeat treatment. Eighty-three percent of recurrent or poorly responsive lesions were associated with high cholesterol. The most resistant patient had four-lid involvement. Excellent cosmetic results and high patient satisfaction were seen. CONCLUSIONS Topical bichloracetic acid is a viable alternative to other modalities in the management of xanthelasma. Advantages include simplicity, cost-effectiveness, speed, safety, and efficacy.
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Affiliation(s)
- L J Haygood
- Department of Dermatology, Case Western Reserve University School of Medicine, Cleveland, Ohio 44483, USA
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Abstract
UNLABELLED BACKGROUND OF OBJECTIVE: Treatment of xanthelasma palpebrarum may prove difficult due to its delicate location at the periorbita and its sometimes extensive dimension. During recent years, carbon dioxide and argon lasers have been used with good results. However, local anesthesia is always required, and there is a concrete risk of scarring and pigmentation changes after the treatment. STUDY DESIGN/PATIENTS AND METHODS In this case report, we describe for the first time the treatment of xanthelasmas with the pulsed dye laser. RESULTS This technique can be carried out without anesthesia and shows excellent cosmetic results. CONCLUSION We see the pulsed dye laser as a good alternative to the hitherto used other two laser types in the treatment of xanthelasma palpebrarum.
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Affiliation(s)
- M P Schönermark
- Department of Otolaryngology, Head and Neck Surgery, Hannover Medical School, Germany
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