Aplicación de láser CO2 para el tratamiento de xantelasmas palpebrales

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.

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.

CO2 Laser Treatment of Xanthelasma Palpebrarum in Skin Types III-IV: Efficacy and Complications After 9-Month Follow-Up

Objective: Ultrapulse CO₂ laser has been used for several decades for removal of xanthelasma lesions. However, most studies to date have focused on Caucasian patients (skin types I-II). We sought to assess the efficacy and complications of CO₂ laser therapy for xanthelasma palpebrarum (XP) in Chinese patients (skin types III-IV). Methods: Data of 38 patients with xanthelasma who received CO₂ laser treatment between December 2013 and January 2016 at our hospital were retrospectively analyzed. Patients were followed up for 9 months. Results: Recurrence occurred in 19/38 (50%) patients. Recurrence was significantly more common in patients with multiple lesions (15/24; 62.5%) than in patients with single lesions (4/14; 28.6%). At 3 months after treatment, the complication rate was 63.16%. The complications included hypopigmentation (23/24; 95.8%) and scarring (1/24; 4.2%). In all patients, the hypopigmentation had disappeared by end of the 9-month follow-up. Conclusions: Ultrapulse CO₂ laser appears to be capable of completely removing XP in patients with medium skin type III-IV. The most common complication is hypopigmentation, but this resolves with time.

Effect of a high-cholesterol diet on lipoprotein metabolism and xanthoma formation in rabbits

BACKGROUND

Xanthelasma is the most common type of cutaneous xanthoma and often occurs on the eyelids. Xanthoma has been reported to be highly correlated with abnormal lipoprotein metabolism.

AIMS

In this study, we wanted to investigate the effects of a high-cholesterol diet on xanthoma formation and lipoprotein metabolism in rabbits.

METHODS

In animals fed with high-cholesterol diet, deteced plasma lipid [ie, total cholesterol (TC), triglycerides (TG), and low-density lipoprotein cholesterol (L-DLC)] levels and pathology of xanthoma.

RESULTS

Plasma lipid levels were dramatically elevated within 8 weeks. In addition, high dietary cholesterol promoted xanthoma formation on the napex. Microscopic examination showed that foam cells laden with cholesterol deposits accumulated around the dermal capillaries and cutaneous appendages within the skin of the napex.

CONCLUSION

These findings indicate a critical role for a high-cholesterol diet in the dysregulation of lipoprotein metabolism and the development of xanthoma in rabbits. The results suggest that abnormal lipid metabolism may increase the occurrence of xanthoma.

Treatment of Xanthelasma Palpebrarum With Intralesional Pingyangmycin

BACKGROUND

Xanthelasma palpebrarum (xanthelasma) is the most common type of cutaneous xanthoma, and many patients tend to seek medical treatments for cosmetic reasons. Many methods treating xanthelasma have been proposed, but none of these options can be regarded as a perfect solution.

OBJECTIVE

To study and evaluate the intralesional injection treatment of xanthelasma with pingyangmycin, which has been widely used as a broad-spectrum antitumor antibiotic.

MATERIALS AND METHODS

21 lesions in 12 patients were treated by intralesional pingyangmycin. Photographs were taken before and after each treatment session. Patients were followed up for 7 to 36 months.

RESULTS

All patients except one received satisfactory results after up to 2 sessions. Only 1 patient had a local recurrence 1 year after the treatment. No severe complications such as infection, atrophy, ulceration, or scar were noticed.

CONCLUSION

Intralesional pingyangmycin is a cheap, effective, and safe treatment for xanthelasma, which has been well accepted by patients.