Systematic review of laser therapy in xanthelasma palpebrarum

Cutaneous signs of selected cardiovascular disorders: A narrative review

Cardiovascular diseases are the leading cause of mortality and morbidity globally. Clinicians must know cutaneous signs of cardiovascular disease, including petechiae, macules, purpura, lentigines, and rashes. Although cutaneous manifestations of diseases like infectious endocarditis and acute rheumatic fever are well established, there is an indispensable need to evaluate other important cardiovascular diseases accompanied by cutaneous signs. Moreover, discussing the latest management strategies in this regard is equally imperative. This review discusses distinctive skin findings that help narrow the diagnosis of cardiovascular diseases and recommendations on appropriate treatment.

A Clinical and Dermatoscopic Perspective of the Efficacy and Safety of Erbium: YAG Laser Ablation Versus 50% Trichloroacetic Acid for the Management of Xanthelasma Palpebrarum

Xanthelasma palpebrarum (XP) is a benign cosmetic condition. Although the role of CO2 laser is well described, there are only a few studies on Erbium: YAG in XP. Similarly, trichloroacetic acid (TCA) is commonly used in XP. However, there are only a few studies comparing these modalities in the treatment of XP.

Aim

To evaluate the effectiveness and safety of Erbium: YAG laser and 50% TCA in the treatment of XP with the role of dermoscope in the evaluation of lesions.

Materials and Methods

A total of 20 subjects were randomly allocated into two groups: group A (TCA) and group B (laser). All patients were subcategorized into three grades viz. I (mild), II (moderate), and III (severe) using a self-devised scoring system.

Results

About 25% and 70% of patients achieved complete clearance in groups A and B, respectively (P = 0.017). The rate of recurrence was 40% and 15% in groups A and B. Dyspigmentation and erythema were the most common side effects. Pretreatment dermoscopic evaluation of the lesion showed a network of brown streaks on a background of a yellowish structureless area and was used to assess the area and margins of the lesion where the adipose tissue was found during the procedure and serial assessment of the lesion.

Clinical and dermoscopic assessment of ablative carbon dioxide laser versus intradermal heparin sodium in xanthelasma

BACKGROUND

Ablative carbon dioxide (CO2 ) laser is still a cornerstone in the management of xanthelasma. However, post-laser complications such as post-inflammatory hyperpigmentation or scarring have to be considered. Heparin sodium was recently suggested as an effective therapeutic modality for xanthelasma.

OBJECTIVE

The aim of this work was to compare the therapeutic value of ablative CO2 laser versus intradermal heparin sodium in xanthelasma.

METHODS

This study was piloted on 30 xanthelasma patients, whose lesions were randomly categorized into two groups. Group A was managed with CO2 laser ablation (2 sessions scheduled every 4 weeks), whereas Group B was managed with intradermal heparin sodium injections (10 sessions scheduled every week). Pre- and post-treatments evaluations were done both clinically and dermoscopically.

RESULTS

Significant reduction of xanthelasma lesions was reported in response to both therapeutic interventions. However, the ablative CO2 laser was more significantly effective than intradermal heparin sodium. Interestingly, intradermal injection of heparin sodium was nearly as effective as ablative CO2 laser in early (<2 years duration) grade I and II xanthelasma, with a lower incidence of post-therapy side effects.

CONCLUSIONS

Intradermal injection of heparin sodium could be suggested as a safe and cost-effective therapeutic technique for early mild grade I and II xanthelasma. Moreover, it could be recommended as a pre-operative management of grade III and IV xanthelasma to reduce the lesions to be easily ablated with CO2 laser.

Lower Eyelid Ectropion Secondary to Over-the-Counter Treatment of Xanthelasma

Xanthelasmas are localized accumulations of lipids, mainly cholesterol, that can occur in the epidermis, dermis, and muscle of the eyelids. They are the most common cutaneous presentation of xanthoma and occur most commonly on the upper eyelid near the inner canthus. Despite their benign presence, xanthelasmas can be cosmetically concerning. With this in mind, several treatment modalities have been described to eliminate the appearance. We report the first case to describe a cicatricial ectropion from the topical treatment, "Glycolic acid, Lactic acid, Mandelic acid, Salicylic acid, Resorcinol, Jessners peel" (XanthelR, 483 Green Lanes, London, N13 4BS).

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.

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%).

Treatment of benign eyelid lesions with Nd:YVO laser: a prospective study

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.

Clinical efficacy of 1,444nm Nd:YAG laser for xanthelasma palpebrarum

Xanthelasma palpebrarum (XP) does not regress spontaneously and most patients complain of cosmetic discomfort. This study presents the results of treatment of XP using 1,444 nm Nd:YAG laser. We aim to evaluate the clinical efficacy of a 1,444 nm Nd:YAG laser in XP. Twenty-eight patients with XP treated with 1,444 nm Nd:YAG laser were analyzed retrospectively. A physician scored the results based on the reduction of the initial lesion area under six categories. The results were scored as follows: no effect (0% clearing of xanthelasma area), some response (1-24% clearing), moderate response (25-49% clearing), marked response (50-74% clearing), satisfactory result (75-99% clearing), and excellent result (100% clearing). Twelve patients (42.8%) showed excellent clearance and 10 patients (35.7%) had clearance greater than 75%. Overall, 24 patients (85.7%) showed improvement higher than 50%. Half of the patients (14 patients) ended the treatment with satisfactory results with one treatment session. Including seven patients who ended the treatment after two laser sessions, 21 patients (75%) reported satisfactory results and ended the treatment after 1 to 2 laser sessions. XP treatment with 1,444 nm Nd:YAG laser showed promising results. We believe it can be an effective and safe treatment modality for XP.

Relationship Between Xanthelasma Palpebrarum and Hyperlipidemia

BACKGROUND

Xanthelasma palpebrarum is a common periorbital lesion that occurs in middle-aged woman. Dyslipidemia was strongly associated with the occurrence of xanthelasma. Different treatment methods for xanthelasma were applied with comparable results.

MATERIALS AND METHODS

This was a retrospective chart review series performed at a single institute. The surgical pathology of 69 patients who received surgical excision from 1994 to 2012 was obtained. In addition, International Classification of Diseases, Ninth Revision, Clinical Modification code of xanthelasma (374.51) of 44 patients who underwent nonsurgical treatment at an outpatient department was acquired from 2006 to 2012. The serum lipid levels, comorbidities, recurrence, and treatment methods were obtained and analyzed with Statistical Analysis System (SAS) 9.4.

RESULTS

Of a total of 113 identified patients, 50 had lipid profile data. Of these 50 patients, 25 (50%) had dyslipidemia, which is higher than general population in Taiwan. The recurrence rate was 17.5%, and there was no statistical difference in the recurrence rate between the different treatment methods.

CONCLUSIONS

Xanthelasma was found to be associated with dyslipidemia. Thus, we recommend patients with xanthelasma to check their lipid profile and receive diet control and lipid-lowering medications for lipid abnormalities.