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Yee DA, Zhou AE, Khachemoune A. Examining treatment strategies for xanthelasma palpebrarum: a comprehensive literature review of contemporary modalities. Arch Dermatol Res 2024; 316:149. [PMID: 38724802 DOI: 10.1007/s00403-024-02863-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 01/29/2024] [Accepted: 04/07/2024] [Indexed: 06/05/2024]
Abstract
Xanthelasma palpebrarum (XP) is the predominant form of cutaneous xanthoma, as it accounts for greater than 95% of cases. It is characterized by the presence of foam cell clusters containing a large amount of low-density lipoprotein (LDL), which are located in the connective tissue of skin, tendons, and fascia. XP lesions commonly present as distinctive yellow-orange macules, papules, or nodules, and are primarily on the upper eyelids as well as the inner canthus. Women are affected twice as often as men, with lesions typically emerging between the ages of 35 and 55. The pathophysiology of XP involves abnormal lipid metabolism and is often associated with hyperlipidemic states like Type II and IV hyperlipidemia, hypothyroidism, weight gain, and fatty diet. Despite the availability of various treatment methods, current XP management lacks standardization, particularly due to limited comparative research. To address this gap, we conducted an extensive literature review of 45 studies published between 2012 to 2023, which provides an updated overview of current XP treatment modalities. This comprehensive analysis will inform researchers and clinicians on the evolving landscape of XP management.
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Affiliation(s)
- Danielle A Yee
- University of Maryland School of Medicine, Baltimore, MD, USA
| | - Albert E Zhou
- Department of Dermatology, UConn Health, Farmington, CT, USA
| | - Amor Khachemoune
- Department of Dermatology, State University of New York Downstate and Veterans Affairs Medical Center, 800 Poly Pl, Brooklyn, NY, 11209, USA.
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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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Tuan H, Chen Y, Yang S, Liu D, Chen D, Zhao Y. 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. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2021; 39:131-136. [PMID: 33449843 DOI: 10.1089/photob.2020.4874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Hsiaohan Tuan
- Department of Dermatology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yongjun Chen
- Department of Cosmetology, Guangdong Provincial Dermatology Hospital, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Sai Yang
- Department of Cosmetology, Guangdong Provincial Dermatology Hospital, Dermatology Hospital of Southern Medical University, Guangzhou, China
| | - Dehua Liu
- Department of Dermatology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Dian Chen
- Department of Dermatology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yi Zhao
- Department of Dermatology, School of Clinical Medicine, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
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Dabas R, Das N, Subramaniyan R, Arora S, Janney M, Lal S. Efficacy of ultrapulse carbon dioxide laser ablation versus 30% trichloroacetic acid in xanthelasma palpebrarum - A randomised controlled trial. JOURNAL OF MARINE MEDICAL SOCIETY 2021. [DOI: 10.4103/jmms.jmms_80_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Sousa-Neves F, Cardoso da Costa J, Braga J, Prazeres S. Treatment of benign eyelid lesions with Nd:YVO laser: a prospective study. J COSMET LASER THER 2020; 22:146-149. [PMID: 32496946 DOI: 10.1080/14764172.2020.1767787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this prospective cohort study, including consecutively selected patients, was to evaluate the outcomes of Nd:YVO laser-assisted photocoagulation for the removal of benign eyelid lesions. An emulsion of lidocaine and prilocaine was used for dermal analgesia and subcutaneous injection of 2% lidocaine was performed as needed. Follow-up included two visits, at day 15 and 45 postoperatively, in order to assess time of wound healing, postoperative complications, need for additional treatment, and patient's satisfaction. A total of 101 lesions of 66 patients were included, with a mean age of 55.4 ± 15.3 years. All patients were Caucasian and 62% were female. Papilloma was the most common lesion identified (61%). No major complications were reported during and after the procedure. Complete epithelization occurred in 82% and 100%, at the 15 and 45-day visit, respectively. All patients were satisfied with the cosmetic result. Only one patient was proposed for additional therapy during the follow-up period. In conclusion, this study supports Nd:YVO laser-assisted treatment as an effective and safe alternative to conventional surgery for the removal of benign eyelid lesions. The technique is well accepted, easy to perform, and provides excellent cosmetic and functional results.
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Affiliation(s)
- Filipe Sousa-Neves
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho , Vila Nova de Gaia, Portugal
| | - João Cardoso da Costa
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho , Vila Nova de Gaia, Portugal
| | - Joana Braga
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho , Vila Nova de Gaia, Portugal
| | - Sandra Prazeres
- Department of Ophthalmology, Centro Hospitalar Vila Nova de Gaia/Espinho , Vila Nova de Gaia, Portugal
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Khode S, Tan SHT, Tan EPA, Uppal S. Xanthelasma Palpebrarum: More than Meets the Eye. Indian J Otolaryngol Head Neck Surg 2019; 71:439-446. [PMID: 31742000 DOI: 10.1007/s12070-018-1345-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 04/05/2018] [Indexed: 10/17/2022] Open
Abstract
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.
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Affiliation(s)
- Shailesh Khode
- Department of Otolaryngology - Head and Neck Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Yishun, 768828 Singapore
| | - Soon Heng Terry Tan
- Department of Otolaryngology - Head and Neck Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Yishun, 768828 Singapore
| | - En-Pei Amanda Tan
- Department of Otolaryngology - Head and Neck Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Yishun, 768828 Singapore
| | - Sandeep Uppal
- Department of Otolaryngology - Head and Neck Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Yishun, 768828 Singapore
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Lee SM, Lew H. Clinical Characteristics of Xanthelasma Palpebrarum and Clinical Effects of Upper Blepharoplasty with Local Flap Technique. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2018. [DOI: 10.3341/jkos.2018.59.9.803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sang Min Lee
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
| | - Helen Lew
- Department of Ophthalmology, CHA Bundang Medical Center, CHA University, Seongnam, Korea
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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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Abstract
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.
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Affiliation(s)
- Pragya A Nair
- Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Gujarat, India
| | - Rochit Singhal
- Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Gujarat, India
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Hu H, Gao Y, Tang J, Zhao Y, Wang H, Jiang H. Effect of a high-cholesterol diet on lipoprotein metabolism and xanthoma formation in rabbits. J Cosmet Dermatol 2017; 17:885-888. [PMID: 29024285 DOI: 10.1111/jocd.12428] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2017] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Hao Hu
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.,The Hospital of Beijing Armed Police Forces, Beijing, China
| | - Yak Gao
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jing Tang
- The Second Hospital of Beijing Armed Police Forces, Beijing, China
| | - Yaozh Zhao
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hui Wang
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hua Jiang
- Department of Plastic and Reconstructive Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
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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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