Xanthelasma palpebrarum: treatment with the ultrapulsed CO2 laser

Plasma Exeresis for the Treatment of Benign Eyelid Lesions: A New Surgical Approach

PURPOSE

To report the plasma therapy technique and its clinical outcomes in patients with benign eyelid lesions.

METHODS

This is a retrospective, noncomparative, interventional study. The study included 71 eyes of 66 patients who underwent plasma exeresis for benign eyelid lesions in our clinic between February 2018 and December 2022. Patient symptoms, cosmetic outcomes, and complications were evaluated.

RESULTS

The lesions were removed with a single plasma exeresis treatment in all patients. The mean size of the lesion at its largest part was 5.5 ± 1.2 mm (range, 3.0-8.8 mm). No complications were encountered during the procedure. The mean procedure time was 4.0 ± 0.7 minutes (range, 3-6 minutes). Postoperatively, only 3 cases (4.2%) with tarsal conjunctival extension had mild irritation symptoms such as pain, discomfort, and redness. The treated areas were fully improved cosmetically, and all patients were satisfied with the cosmetic outcomes.

CONCLUSIONS

The plasma therapy technique for removing benign eyelid lesions offers minimally invasive surgery, less discomfort, fast recovery, and successful anatomical and cosmetic outcomes.

Interventional and device treatment of the periocular area

Growth in the research, innovation, and development of laser and energy-based technologies over the past few decades has led to dramatic increases in treatment options for dermatologic and cosmetic concerns of the periorbital area. We highlight recent treatment options using laser and energy-based devices for the clearance of periocular pigmented lesions, including solar lentigines and nevus of Ota; vascular lesions, including port-wine birthmarks, infantile hemangiomas, superficial telangiectasias, and reticular veins; laser ablation of benign tumors, such as xanthelasma; cosmetic rejuvenation; treatment of infraorbital dark circles and festoons; laser removal of eyebrow and eyeliner tattoos; and device-based treatment of chronic dry eyes.

A Practical Review of the Management of Xanthelasma palpebrarum

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.

A Comparison of Efficacy and Safety of Fractional Carbon Dioxide Laser and Fractional Er:YAG Laser for the Treatment of Xanthelasma Palpebrarum: A Two-Center Randomized Split-Face Controlled Trial

Background: Xanthelasma palpebrarum (XP) is a form of cutaneous xanthoma that presents as collections of yellowish papules or plaques around the eyelids or canthus, affecting patients cosmetically. Objective: This study aimed to compare the efficacy and safety of fractional carbon dioxide (CO₂) laser to that of fractional Er:YAG laser for the treatment of XP. Methods: Two centers recruited patients diagnosed with XP of bilaterally symmetrical lesions. The lesion on one side was randomly assigned to be treated with fractional CO₂ laser while the lesion on the other side was treated with fractional Er:YAG laser. All subjects received up to five treatments, with a 4-week interval between each treatment. Results: Thirty-nine patients completed the study and a total of 82 lesions were available for final assessment. The percentage of "Excellent Improvement" on third and fourth visit was 60.98% versus 39.02% and 90.24% versus 63.41%, respectively, p < 0.05. In a follow-up for 12 to 25 months, the number of lesions recurred on the side treated with fractional CO₂ laser and fractional Er:YAG laser are 9 (22%) and 10 (24%), respectively. Conclusions: In this study, fractional CO₂ laser therapy appears superior since a fewer treatments are required for patients to show significant clinical improvement.

Successful treatment of xanthelasma palpebrarum with a combination of radiofrequency ablation and wound suturing

BACKGROUND

Xanthelasma palpebrarum is a common disfiguring condition of eyelids often causing cosmetic concern and psychological distress. Various treatment modalities have been used to clear the lesions but none have been found to be fully satisfactory.

AIMS

To evaluate a novel combination of radiofrequency (RF) ablation and primary wound closure for treatment of xanthelasma palpebrarum (XP).

METHODS

Forty-five patients were selected after clinical examination and grading of lesions. Radiofrequency ablation was used to remove the lesion followed by suturing of the wound. Efficacy of treatment was evaluated on the basis of clinical examination and photographic images.

RESULTS

Excellent response was seen in all patients. Of these, in 43 patients complete clearance could be achieved in a single sitting. In the other 2, an additional sitting of RF was done because of the presence of either multiple lesions or significant projection from the main lesion. Recurrence was seen in only two patients at the end of one year.

CONCLUSION

Radiofrequency removal combined with wound closure showed excellent response with good cosmetic result, no scarring, and rare relapse at end of 1 year. This was achieved in 43(96%) of the total 45 patients in a single sitting.

Fractional CO2 laser versus trichloroacetic acid 50% for xanthelasma palpebrarum therapy

BACKGROUND

Although being a benign lesion, xanthelasma palpebrarum (XP) causes cosmetic concerns. There are numerous therapeutic methods for XP with adverse events for each method.

AIMS

Evaluate the safety, efficacy, and downtime of fractional CO₂ laser (10 600 nm) versus 50% trichloroacetic acid (TCA) in XP therapy.

PATIENTS/METHODS

Comparative interventional prospective study involved 20 adult patients with XP. Each patient received a split-face therapy where xanthelasma lesions treated with fractional CO₂ laser on the one side and TCA 50% on the other side for maximum 5 sessions with 2-week intervals in between.

RESULTS

Statistically significant improvement in lesion color, thickness, and size by both fractional CO₂ and TCA 50%, with nonstatistically significant difference between both therapeutic modalities after treatment, although downtime, number of sessions, and patient's satisfaction were significantly better for fractional CO₂ laser.

CONCLUSION

Fractional CO₂ laser (10 600 nm) is ideal for treatment of xanthelasma because it is safe and effective with short downtime, more patient satisfaction, less sessions, and less complications compared with chemical peeling using TCA (50%).

Xanthelasma Palpebrarum: More than Meets the Eye

Xanthelasma palpebrarum (XP) is the most common form of cutaneous xanthomata, and is important aesthetically, because of its close relation to the eyes, as well as medically for its association with cardiovascular disease (CVD). To provide avant-garde review discussing the various aspects of XP, including its aetio-pathogenesis and various treatment modalities. A structured Pubmed and Medline were searched for relevant articles. The finding of recent research has strongly espoused the link between XP and CVD, and mechanisms have been suggested for its formation. The new technologies have led to a multitude of treatment options for XP. XP is a multi-faceted entity; other than simple treatment of the cosmetic aspect of the disease, one must be cognizant of its cardiovascular implications.

Xanthelasma: An Update on Treatment Modalities

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.

Xanthelasma palpebrarum - a brief review

Xanthelasma palpebrarum is the most common cutaneous xanthoma, characterized by yellowish plaques over eyelids – most commonly, over the inner canthus of the upper lid. It is triggered by hyperlipidemia, thyroid dysfunction, and diabetes mellitus. Xanthelasma results from perivascular infiltration of mono- and multinucleated foam cells within lipid-laden cytoplasmic vacuoles in the superficial reticular dermis. Different modalities of treatment, such as simple surgical excision, cryotherapy, chemical peeling with trichloroacetic acid, radiofrequency, and laser, are used in the treatment of xanthelasma palpebrarum. A brief review of current treatment strategies is presented here.

EXPERIENCE OF REMOVING BENIGN NEOPLASMS OF SKIN IN CERVICOFACIAL AREA USING THE METHOD OF PLASMA ABLATION

Choosing appropriate methods for removal of benign skin lesions (BSL) in the cervicofacial area has always been an important and challenging issue. Removal of the BSL is indicated and performed for medical and aesthetic reasons. A method with less painful procedures, a short healing period, without noticeable long-lasting traces (such as scars, dyschromia) and, predictably, fewer repeat procedures is preferred. Objectives. Evaluation of the effectiveness, safety and convenience of BSL plasma ablation using Plexr® (GMV, Italy); Comparison of the reparative processes speed after the BSL removal in the cervicofacial area applying the Plexr® device with other instrumental methods (based on literature reviews). Materials and Methods. We identified a group of patients wishing to remove papilloma, xanthelasma, dermal nevi, dermatofibroma on their face and body. Neoplasms (skin lesions) were assessed visually and by means of the Dermlite 3DN dermatoscope. Patients with atypical skin lesions were excluded from the study and referred to a medical oncologist for consultation. Each patient, having been fully briefed on the nature and course of the medical procedure, as well as required aftercare, submitted their written informed consent. Plasma ablation of BSL was performed using Plexr® device. Re-examination of patients was carried out after the scab from the treated area of the skin had fallen off. Results. We have performed 373 BSL removal procedures, including 212 (57%) — in the cervicalfacial area, among which there have been 47 (13%) cases of acrochordoni, papilloma, xanthelasma, syringoma and upper and lower eyelid milia removals. Complete healing has been recorded in 98% of all cases, with repeated corrective procedure being required only for one patient due to insufficiently deep tissues destruction in the course of multiple syringoma removal in the lower eyelid area. Conclusion. The results obtained allow to consider the method of BSL tissues plasma ablation applying Plexr® device effective, safe, non-traumatic, inexpensive, with a short period of tissue healing (7—10 days). BSL removal with the help of Plexr® — is a good alternative to conventional surgical and laser methods, which can be introduced into medical practice.

Treatment of xanthelasma palpebrarum with a 1064-nm, Q-switched Nd:YAG laser

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.

Inflammatory Mediators in Xanthelasma Palpebrarum: Histopathologic and Immunohistochemical Study

PURPOSE

To evaluate the expression of inflammatory mediators in xanthelasma palpebrarum.

METHODS

In this retrospective histopathologic case-control study, xanthelasma specimens obtained from the private practice and pathology archives of 1 author (R.Z.S.) were analyzed and compared with the blepharoplasty tissues from age- and sex-matched controls. Paraffin-embedded tissue sections were stained with hematoxylin-eosin and CD3, CD20, CD163, cyclooxygenase-1, inducible nitric oxide synthase, matrix metallopeptidase-9, and myeloperoxidase antibodies. Immunostaining was quantified by light microscopy and with a computerized image analysis system of scanned images.

RESULTS

Hematoxylin-eosin-stained preparations of xanthelasma specimens demonstrated significantly more intense chronic lymphocytic infiltrate when compared with the control blepharoplasty tissues (p < 0.001). Immunohistochemical studies revealed more intense CD3+ T cell and CD163+ histiocytic infiltrate (11% vs. 5%; p = 0.02 and 28% vs. 5%; p = 0.003, respectively) and increased expression of cyclooxygenase-1 (44% vs. 20% expressing cells; p < 0.001 and 21% vs. 9% strongly expressing cells; p = 0.008) and inducible nitric oxide synthase (43% vs. 26% expressing cells; p = 0.03 and 42% vs. 25% strongly expressing cells; p = 0.02) in xanthelasma specimens compared with control tissues.

CONCLUSIONS

The inflammatory milieu in xanthelasma appears to be analogous to descriptions of the early stages of cardiac atherosclerotic plaque formation. These findings may contribute to the understanding of xanthelasma pathogenesis and to the development of potential targeted therapies.

Erbium:yttrium aluminum garnet laser versus Q-switched neodymium:yttrium aluminum garnet laser for the treatment of xanthelasma palpebrarum

BACKGROUND

Several lasers have been used for the treatment of xanthelasma palpebrarum (XP), such as Q-switched neodymium:yttrium aluminum garnet (QSNd:YAG) and erbium:yttrium aluminum garnet (Er:YAG) laser. Up to now, a comparative study among these laser options in the treatment of XP has not been reported.

OBJECTIVE

The aim of this study was to compare the clinical efficacy and response rates of QSNd:YAG and Er:YAG in the treatment of XP.

METHODS

Sixty patients with a total of 102 XP lesions were randomly and equally divided into two groups. The first group was treated with QSNd:YAG at a fluence of 10 joule/cm², 10 Hz and 2 mm spot size, and the second group was treated with Er:YAG at 200-300 millijoule, 4 Hz and 2 mm spot size.

RESULTS

In the Er:YAG group, the percentage of patients who required 3 or 4 sessions and wound healing time were higher compared to those of the QSNd:YAG group. Furthermore, the percentage of patients who had an improvement score of 4 was higher in the Er:YAG than that in the QSNd:YAG group.

CONCLUSION

Er:YAG is an efficient, successful and minimally invasive method without long-lasting adverse effects.

Continuous Wave Potassium Titanyl Phosphate Laser Treatment is Safe and Effective for Xanthelasma Palpebrarum

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.

Laser treatment of periocular skin conditions

Advances in laser technology in recent decades have increased the options for the treatment of dermatologic conditions of the eye and eyelid. Benign tumors can be laser-ablated with relative ease, and vascular and melanocytic lesions can be precisely targeted with modern lasers. In this contribution, we review treatment of periocular pigmented lesions, including melanocytic nevi and nevus of Ota; vascular lesions including telangiectasias, port wine stains, and infantile hemangiomas; hair removal; eyeliner tattoo removal; laser ablation of common benign periocular tumors, such as syringomas, xanthelasma, milia, and seborrheic keratoses; and laser resurfacing. The recent advent of fractionated laser technology has resulted in dramatically decreased healing times for periocular skin resurfacing and fewer adverse effects. Fractionated laser resurfacing has now nearly supplanted traditional full-field laser resurfacing, and safe treatment of rhytides on the thin skin of the eyelids is possible. Proper eye protection is, of course, essential when using lasers near the eye. Patient preparation, safety precautions, and risks--intraocular and extraocular--are discussed herein. As laser technology continues to advance, we are sure to see improvements in current treatments, as well as development of new applications of cutaneous lasers.

Treatment of genital lesions with diode laser vaporization

Background

Genital warts caused by human papillomavirus (HPV) infection are the most common sexually transmitted disease leading to anogential lesions. Although the laser therapy has been shown to be effective in a number of conditions, the use of laser diode vaporization in urological applications and the understanding on its effectiveness as a treatment for various urological conditions is limited. Therefore, the aim of this study was to evaluate the efficacy of diode laser vaporization as a treatment for genital lesions.

Methods

Patients presenting with genital lesions at the urology outpatient clinic at Coronel Mota Hospital, between March 2008 and October 2014, were enrolled into the study. Data collected included age, gender, duration of the lesion, site of the lesion and numbers of the lesions, length of follow-up, recurrence of lesions after treatment and whether there were any complications.

Results

A total of 92 patients were enrolled in the study; 92.4% (n = 85) male; mean age (± SD) 27.92 ± 8.272 years. The patients presented with a total of 296 lesions, with a median of 3 lesions each, including penis (n = 78), urethra (n = 4) lesions, and scrotum (n = 2) lesions. Lesions ranged in size from 0.1 to 0.5 cm², most commonly 0.3 cm² (n = 38; 41.3%), 0.4 cm² (n = 21; 22.8%) or 0.5 cm² (n = 20; 21.7%). Patients most commonly reported that they had their lesions for a duration of 12 (n = 29; 31.5%) or 6 months (n = 23; 25.0%). Eighteen patients (19.6%) had a recurrence after their 1^st/conventional treatment. There were no incidences of post–operative infection or complications from the laser diode vaporization.

Conclusions

Laser diode vaporization can be considered as an alternative method for treating genital lesions in urology, with satisfactory results in terms of pain, aesthetic and minimal recurrence.

Ultrapulse carbon dioxide laser ablation of xanthelasma palpebrarum: a case series

Context:

Xanthelasma palpebrarum is the most common form of xanthomas. Albeit a benign entity, it is cosmetically disturbing and a frequently recurring dermatologic referral. Although the classical treatment option remains surgical excision, alternatively, chemical cauterization, cryosurgery and electrofulguration have all been tried in the past with mixed results. The use of laser systems such as carbon dioxide laser, Erb:YAG laser, Q-switched Nd:YAG laser, diode laser, pulsed dye laser and KTP laser have become popular in the treatment of these lesions. Recent literature suggests minimal pigmentary changes and scarring with the use of ultrapulse carbon dioxide laser treatment of these lesions.

Aim:

To study and evaluate the effectiveness of ultrapulse carbon dioxide laser ablation for treatment of xanthelasma palpebrarum.

Materials and Methods:

10 patients presenting with bilateral xanthelasma palpebrarum, new and with recurrence were studied for results after a single treatment with ultrapulse carbon dioxide laser (10,600 nm; 100-200 Hz; 200-400 μsec). The follow-up time was 9 months.

Results:

All lesions were treatable with a single-laser treatment session. Two patients (20%) developed recurrence during the follow-up period. Side effects included post inflammatory hyperpigmentation in two patients (20%), but no visible scarring was observed.

Conclusions:

The ultrapulse carbon dioxide laser is an effective and safe therapeutic alternative in treatment of xanthelasma palpebrarum.

Argon laser versus erbium:YAG laser in the treatment of xanthelasma palpebrarum

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.

Laser treatment of giant xanthelasma palpebrarum

Xanthelasma palpebrarum is the most common cutaneous xanthoma. It typically presents in middle-aged and older adults, most often around the eyelids. The diagnosis is made clinically. Giant xanthelasmas palpebrarum are xanthelasmas that extensively affect the superior and inferior bilateral eyelids. Many techniques have been put forward for treating these lesions (surgical, laser, and chemical techniques), but we describe our experience in the treatment of giant xanthelasmas by ultrapulsed CO2 laser. Between 2009 and 2012, in the Division of Plastic and Reconstructive Surgery at the University of Palermo, 12 patients with giant xanthelasmas were treated using a CO2 laser. The laser parameters are as follows: frequency 20 Hz, energy 75 mJ, and power 1.5 W. Each laser session lasts 15 min; the treatment consists of three or four sessions that are carried out at intervals of 15 days. Patients were followed up after 2, 6, and 12 months. This technique is rapid and it is accepted very well by patients. The only disadvantage is a long healing time (10-15 days). The ultrapulsed CO2 laser, in experienced hands, is an excellent device that enables the complete removal of giant xanthelasmas with a minimally invasive but very effective technique.

Outcomes of surgical management of xanthelasma palpebrarum

Background

Xanthelasma palpebrarum (XP) is a benign disorder manifesting as yellowish cholesterol-laden plaques on the eyelids. This paper presents the outcomes in patients with XP who have undergone surgical excision as the main modality of treatment.

Methods

A retrospective review of patients who received surgery for xanthelasma palpebrarum from March 2007 to March 2011 was conducted. Patients were classified into four grades according to the location and extent of the lesion, with grade I being the mildest and grade IV being the most diffuse. Simple excision was performed in grade I and II lesions, while local flaps and skin grafts were performed in the more advanced grades.

Results

Ninety-five cases from March 2007 to March 2011 were included in this study. 66 cases (70%), were treated by simple excision. Twenty-four cases (25%) and 5 cases (5%) were treated by simple excision in combination with or without local flaps and skin grafts. In approximately 1/4 of the patients, orbicularis oris muscle involvement was observed. 4 patients (4.2%) developed scar contracture postoperatively, which required a secondary procedure. Recurrence was reported in 3 patients (3.1%). Otherwise. There were no other reports of major complications or disfigurement.

Conclusions

We found that for lesions involving the deep dermis and/or muscle, surgical excision was the most appropriate therapeutic option.

Efficacy and safety evaluation of an innovative CO2 laser/radiofrequency device in dermatology

BACKGROUND

CO2 laser has not only become the most widely used laser in dermatological surgical practice, but it has also proved to be highly effective in treating aesthetic imperfections.

OBJECTIVE

To examine the efficacy and safety of a novel fractional CO2 laser combined with a radiofrequency device in different dermatological, surgical and aesthetic fields.

METHODS

A total of 79 patients were treated in our Outpatient Service with a novel fractional CO2 laser combined with a bipolar radiofrequency device for a maximum of 5 months. Group A consisted of 39 patients with lesions requiring complete excision, whereas Group B consisted of 40 subjects seeking to enhance aesthetic facial imperfections. The results were assessed by three 'blind' investigators using photographs and clinical observations; in addition, the patients had to give their own subjective assessment of the results.

RESULTS

At the 6-month follow-up, the lesions of the Group A patients had been completely removed, except for one case of a large sebaceous nevus on the scalp. All the Group B patients showed global improvement in skin tightening, removal of fine lines and rhytides and correction of dilated pores and hyperpigmentation, with no significant side-effects and short downtimes.

CONCLUSION

This kind of laser meets the needs of the majority of dermatologists requiring a unique, versatile tool to remove cutaneous lesions and at the same time, safely and effectively treat skin imperfections.

Xanthelasma palpebrarum treatment with a 1,450-nm-diode laser

BACKGROUND

Various treatments of xanthelasma palpebrarum have been studied, including surgical excision, treatment with chemicals, and ablative laser therapy, but these methods have some disadvantages. Recently, nonablative laser therapy has been proposed as a treatment for xanthelasma palpebrarum.

OBJECTIVE

To investigate the efficacy and safety of a 1,450-nm-diode laser in the treatment of xanthelasma.

MATERIALS AND METHODS

Sixteen patients were treated using a 1,450-nm-diode laser. Fluences of 12 J/cm(2) , a 6-mm spot size, and a dynamic cooling device setting of 20 to 30 ms were used. One to four treatments 4 to 6 weeks apart were given to each patient. Photographs were taken before each treatment session and 4 to 6 weeks after the last treatment.

RESULTS

Two (12.5%), eight (50%), and four (25%) of the 16 patients were scored as having some (20-40% clearing), moderate (40-60% clearing), and marked (60-80% clearing) improvement, respectively. Focal mild transient hyperpigmentation was noted in five patients. Post-treatment local swelling lasted 3 to 4 days.

CONCLUSION

The 1,450-nm-diode laser treatment is a new, valuable treatment option for xanthelasma palpebrarum, offering relatively mild side effects. Studies including long term follow up and a comparison with alternative treatment modalities are necessary to further assess the clinical utility of this treatment. The authors have indicated no significant interest with commercial supporters.

Carbon dioxide laser guidelines

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.

Non-surgical treatments of primary, non-melanoma eyelid malignancies: a review

The diagnosis and management of periocular cutaneous malignancies are essential components of an ophthalmologist's practice. Skin cancers comprise nearly one-third of newly diagnosed malignancies. Furthermore, the incidence of skin cancer appears to be increasing. Multiple treatment modalities exist for periocular cutaneous malignancy. Surgical extirpation, often with the combined expertise of a Mohs micrographic surgeon, is typically the first line therapy and is often curative in the periocular region, depending on a variety of factors, including tumour histology, specific location, depth of invasion and surgical technique. However, there are instances where a less invasive, non-surgical treatment option is warranted, including patients who are poor surgical risks or those with diffuse disease. The purpose of this article is to review the literature and describe the non-surgical treatment options, indications and efficacies for non-melanoma primary eyelid malignancies.

KTP-Laser-Koagulation bei Xanthelasma palpebrarum. KTP laser coagulation for xanthelasma palpebrarum

BACKGROUND

Xanthelasma palpebrarum is a benign skin disorder of unknown etiology appearing as one or multiple yellowish plaques around the eyelids. Hyperlipidemia, thyroid dysfunction, and diabetes mellitus are possible pathogenetic triggers. Removal of xanthelasma is desired for aesthetic reasons. While there are many treatment options, search continue for newer methods with less scarring and post-inflammatory hyperpigmentation.

PATIENTS AND METHODS

We employed for the first time KTP laser (532 nm) for the treatment of 14 patients with xanthelasma palpebrarum on 33 eyelids.

RESULTS

More than 70% of the patients tolerated KTP laser irradiation without any analgesia. 85.7% showed respectable reduction of xanthelasma palpebrarum after one to three treatment sessions without side effects.

CONCLUSIONS

KTP laser irradiation represents a minimally invasive, safe and effective treatment option for the reduction of xanthelasma palpebrarum without undesired side effects.

New operative technique for treatment of xanthelasma palpebrarum: laser-inverted resurfacing: preliminary report

Xanthelasma palpebrarum lesions are benign but present cosmetic problems to the patient. Their surgical removal has also presented problems to the surgeon. A new laser operative technique for xanthelasma palpebrarum is introduced to avoid the risk for scarring and pigmentary changes after vaporization of eyelid tissue to remove benign lesions, for example, xanthelasma. The authors propose pulsed erbium yttrium aluminum garnet (Er:YAG) vaporization of the lipomatous tissue off the inner surface of the eyelid after incision and eversion of the incised tissue to expose the xanthelasma. The Er:YAG is the laser of choice because of its high absorption in water and thus its self-limiting depth of penetration coupled with extremely precise tissue ablation. Two illustrative case reports are presented, with no recurrence seen in a maximum of 1 year of follow-up. This technique offers the following advantages: no excision of tumor tissue is required (bearing in mind the high rate of recurrence of this lesion) and this wavelength allows good control of tissue removal and accurate recognition of the end point.

Xanthelasma palpebrarum: treatment with the erbium:YAG laser

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.

Histopathologic and morphometric evaluation of the skin abnormalities induced by erbium:YAG and carbon dioxide lasers in 10 patients

In the 1960s, carbon dioxide (CO2) laser therapy started to be applied to eliminate wrinkles, actinic scars, and acne because of its capacity of induce intracellular water vaporization. However, recent studies have shown the efficacy of the erbium laser in removing delicate and moderate scars. Furthermore, the postoperative lesions induced by the erbium laser seem to resolve faster and with less erythematous pattern compared with lesions induced by the CO2 laser. The purpose of this study was to determine the immediate pathologic alterations caused by single applications of CO2 and erbium lasers and their association in human skin shreds. Ten white female patients aged 30 to 63 years underwent rhytidectomy, and their respective shreds, which were prepared for excision, were tattooed with the CO2 laser, the erbium laser, or a combination of both in random order and number of applications, before final removal. This project was approved by the local ethical committee. After surgical removal, these tattooed shreds were fixed in 10% buffered formalin and submitted to histopathologic analysis. Morphometric studies demonstrated the normal skin thickness and thickness of the laser-treated area, and their subtraction resulted in the ablation damage values. Residual thermal damage corresponded to the thickness of the affected skin from the most superficial layer of tissue in the laser-treated area down to the deepest dermal area with basophilic degeneration of collagen fibers. Our results showed that two CO2 applications resulted in greater ablation and residual thermal damage when compared with only one CO2 application. The same was true in comparisons of one and two applications of the erbium laser. Both results were statistically significant (p < 0.05). When one isolated erbium and one isolated CO2 application were compared, ablation damage was greater in the former group, although with no statistical significance. One CO2 plus one erbium application compared with one isolated CO2 application showed similar ablation damage but greater residual thermal damage in the latter group (p < 0.05). These observations might contribute to our understanding of the lesions caused in the human skin by erbium and CO2 lasers and eventually help determine the ideal laser combination for the appropriate surgical treatment.