Complete Blood Cell Count-Derived Inflammation Biomarkers in Patients with Xanthelasma Palpebrarum

Objectives

Xanthelasma palpebrarum (XP) is the most common type of cutaneous xanthoma, characterized by yellowish cutaneous plaques commonly located near the medial canthus of the eyelid. Although dyslipidemia significantly contributes to its development, inflammation is also believed to be another element in the pathogenesis, especially in normolipidemic patients. Recently, cell counts derived from complete blood counts have been identified as indicators of systemic inflammatory conditions and have also been under discussion concerning their relevance to ocular diseases. This study aimed to assess inflammation indices derived from complete blood cell counts (CBC) in XP patients with normal lipid levels.

Methods

Patients who had been referred to the oculoplasty department with the diagnosis of XP between January 2020 and January 2023 and age-matched control subjects were retrospectively reviewed. Patients who had abnormal lipid profiles and systemic diseases such as diabetes mellitus, hypertension, malignancy, cardiovascular diseases, systemic infections, and inflammatory diseases were not included in the study. CBC parameters were analyzed and compared between the groups.

Results

The study comprised 27 normolipidemic patients with XP and 27 age-matched healthy individuals as the control group. There were no statistically significant differences between the two groups in terms of age (p=0.143). The mean hemoglobin, neutrophil, monocyte, lymphocyte, platelet, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, and aggregate index of systemic inflammation values were higher in the patient group, but the differences were not statistically significant (p>0.05). The mean red cell distribution width and platelet-to-lymphocyte ratio appeared to be lower in the patient group compared to the control group; however, no significant differences were observed between the two groups (p=0.272, p=0.387, respectively).

Conclusion

This study might offer insights into the pathogenesis of XP, yet numerous questions remain unanswered, awaiting further investigation in future studies.

Digital Patient Education on Xanthelasma Palpebrarum: A Content Analysis

Patient education has been transformed using digital media and online repositories which disseminate information with greater efficiency. In dermatology, this transformation has allowed for patients to gain education on common cutaneous conditions and improve health literacy. Xanthelasma palpebrarum is one of the most common cutaneous conditions, yet there is a poor understanding of how digital materials affect health literacy on this condition. Our study aimed to address this paucity of literature utilizing Brief DISCERN, Rothwell's Classification of Questions, and six readability calculations. The findings of this study indicate a poor-quality profile (Brief DISCERN < 16) regarding digital materials and readability scores which do not meet grade-level recommendations in the United States. This indicates a need to improve the current body of educational materials used by clinicians for diagnosing and managing xanthelasma palpebrarum.

Possible roles of human mast cells in the formation of xanthelasma palpebrarum

Cutaneous xanthoma consist of foam cells that originate from monocytes or macrophages and accumulate in perivascular areas of the skin. The main component of these cells is oxidized low-density lipoprotein (oxLDL). In this study, we show that mast cells surround the accumulated foam cells, suggesting their involvement in xanthoma formation. Coculture of THP-1 or U937 monocytes with the human mast cell line LUVA upregulated their uptake of oxLDL. Positive staining for intracellular cell adhesion molecule-1 (ICAM-1) at the borders between mast cells and foam cells was seen in pathological specimens of the most common cutaneous xanthoma, xanthelasma palpebrarum, and in cocultures. In the latter, ICAM1 messenger RNA levels were upregulated. The administration of anti-ICAM-1 blocking antibody inhibited the increase in oxLDL uptake by THP-1 or U937 monocytes cocultured with LUVA. Taken together, these results suggest a role for mast cells in the formation of xanthelasma palpebrarum and the involvement of ICAM-1 in this process.

Efficacy and Safety of Erbium-YAG Laser Ablation Therapy in Superficial Dermatoses: The Workhorse of Dermatology

Background

Erbium-YAG laser has been the working horse in dermatology for years. Surprisingly, data on the efficacy and adverse effects of this novel resurfacing and ablative technique of erbium-YAG laser for superficial dermatoses in Indian skin is limited.

Aim and Objective

To evaluate the efficacy and safety profile of erbium-YAG laser ablation in superficial cutaneous lesions.

Materials and Methods

Two hundred and fifty patients of various superficial dermatoses, treatable by erbium-YAG laser, were recruited in the study. All the patients were subjected to erbium-YAG laser sessions. The number of laser sessions, fluence, frequency and other parameters were individualized as per the respective dermatosis. The clinical response was evaluated as grade 4 (100% lesion clearance), grade 3 (75-99%), grade 2 (50-75%) or grade 1 (<50%).

Results

The overall mean age of our study group was 37.70 years. In our study, 52.38% cases of verruca plana, 36.84% cases of seborrheic keratosis, 56.4% cases of xanthelasma palpebrarum, 22% cases of acquired melanocytic nevus, 23.8% cases of plantar wart and 40% cases of sebaceous hyperplasia showed complete clearance. The most common adverse effect was post-laser erythema in 50.4% of cases, followed by pain in 36.8%. Besides this, scarring and dyspigmentation were observed in 11.6% and 12% of cases, respectively. The rate of recurrence on 3 months follow-up was 9 (23.07%) cases in xanthelasma palpebrarum, 11 (28.9%) cases in seborrheic keratosis, 10 (23.8%) cases in verruca plana and 9 (42.8%) cases in plantar warts.

Conclusion

This study suggested that erbium-YAG ablation achieved good results for superficial lesions like verruca plana, seborrheic keratosis, xanthelasma palpebrarum, plantar wart, sebaceous hyperplasia and acquired melanocytic nevus. Thus, Er: YAG laser can offer a one-step procedure with better cosmetic results and a lesser rate of recurrence.

Animal experimental research of intralesional bleomycin and pingyangmycin in the treatment of xanthoma

BACKGROUND

Xanthelasma palpebrarum is a type of human xanthoma that occurs on the skin of human eyelids and is a benign skin lesion. Pingyangmycin (also known as bleomycin A5) is one of the 13 components of bleomycin. The aim of this study was to explore the efficacy of intralesional bleomycin and pingyangmycin in the treatment of xanthoma based on histopathological observations in animal experimental research.

METHODS

An animal model of xanthoma was established by feeding rabbits with a high-cholesterol diet. Pingyangmycin and bleomycin interfered with the skin xanthoma of the animal model. Skin tissue specimens were stained with hematoxylin-eosin and oil red O to evaluate the effect of the intervention.

RESULTS

A xanthoma animal model was established. Pingyangmycin and bleomycin could reduce the abnormal lipid deposition in the lesion area of the skin xanthoma of the animal, via a local injection. In addition, pingyangmycin was more effective than bleomycin in eliminating lipid deposition in rabbit skin xanthoma.

Xanthelasma palpebrarum removed with Atmospheric Plasma technique: 11-year follow up

Xanthelasma palpebrarum is a subcutaneous lesion of the lid and cause a cosmetical issue. The aim of the present study was to evaluate the atmospheric plasma treatment for the treatment of xanthelasma with an 11-year follow up. Seventy-two patients with bilateral xanthelasma and 26 patients with unilateral xanthelasma by atmospheric plasma technique known also as voltaic arc dermabrasion (VAD, Europe Medical s.r.l. Montesilvano (PE), Italy). Photographs were obtained at the baseline and after the procedure and analyzed by an independent observer. The evaluation of the results was made 2 months after this single treatment with 11 years of follow up. The subjects average age was 48.5 years (range 41-63 years). All subjects were elected for a single session for the lesion removal. The erosion is epithelialized from the lesion margins and the dermal basal cells. After 2 months from the treatment, the result was scored as 4 (clearing of lesions > 75%, complete resolution) in 66 patients for a total of 104 lesions treated; scored as 3 in 24 patients for a total of 48 lesions, and as 2 in nine patients for a total of 18 lesions. No subjects scored 0 or 1. A total of 8 lesions showed mild erythema in the treated areas for 1 month. Numerous approaches were proposed for xanthelasma exeresis such as a surgical treatment especially in case of excessively large lesions or lesions involving the medial canthus that could produce a more limited skin laxity rapidly induces a risk of ectropion. In conclusion, the effectiveness of the present investigation suggest that the atmospheric plasma is a useful therapeutic option for the treatment of xanthelasma palpebrarum.

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.

Clinical and serum lipid profiles and LDLR genetic analysis of xanthelasma palpebrarum with nonfamilial hypercholesterolemia

BACKGROUND

XP is a flat xanthoma that usually presents as bilateral, symmetrical, soft, yellowish papules over the eyelids. The etiology of XP is unknown, but it may be related to complex heterozygous mutations.

AIMS

To investigate the lipid profiles, important clinical characteristics, and low-density lipoprotein receptor (LDLR) gene mutation in the patients suffering from xanthelasma palpebrarum (XP) with nonfamilial hypercholesterolemia.

PATIENTS/METHODS

The prospective study included 25 individuals of XP with nonfamilial hypercholesterolemia, and 30 controls neither with XP nor familial hypercholesterolemia (FH). Each one underwent detailed clinical examination, serum lipid profile, and LDLR gene detection at the 400th exon and the 1246th exon.

RESULTS

In our study, patients with XP were often not present with FH and family history. The mean serum cholesterol (CHOL) (5.20 ± 1.82) and the prevalence of carotid atherosclerosis (4.34 ± 0.78) were significantly higher in study group, while there was no statistically significant difference between two groups in terms of triglyceride (TG) (P = .38) and low-density lipoprotein (LDL) (P = .23). Unusually, the mean levels of high-density lipoprotein (HDL) (1.59 ± 0.31) in the study group were much higher than the controls (1.31 ± 0.30), and the LDLR gene mutation was not found.

CONCLUSION

Clinical and serum lipid profiles indicated that XP was sporadic and underlying lipid abnormalities especially higher HDL. XP did not occur with mutations in the LDLR gene at the two exons. We suggested too high HDL level may be contributed to pathogenesis of XP and XP is often not associated with FH.

Intralesional injection of bleomycin in the treatment of xanthelasma palpebrarum: A clinical study

BACKGROUND

Xanthelasma palpebrarum (XP) is the most common type of cutaneous xanthoma and has been treated with intralesional injection of pingyangmycin effectively. However, bleomycin, which has the same effect in antitumor activity as pingyangmycin, has not been applied in the treatment of XP.

AIMS

To explore and assess the treatment of xanthelasma by intralesional injection of bleomycin, which has been widely used as an antitumor antibiotic, for the replacement of pingyangmycin.

METHODS

Intralesional injection of different concentrations of bleomycin was administered to 44 xanthelasma lesions of 24 patients who have never been treated before, divided into two groups according to age. Photographs were taken and analyzed to assess the therapeutic efficiency. Patients were then followed up for 6-24 months.

RESULTS

All the lesions resolved after 1 month of treatment with the intralesional injection of different concentrations of bleomycin. There was no significant difference observed between the two groups. No severe complications had occurred.

CONCLUSION

The treatment of XP with intralesional injection of bleomycin is minimally invasive, safe, and effective. Consequently, it also has good cosmetic outcome with no adverse effects.

Serum lipids and risk of atherosclerosis in xanthelasma palpebrarum: A systematic review and meta-analysis

BACKGROUND

The association between dyslipidemia and xanthelasma palpebrarum (XP) remains controversial, and no definite evidence has indicated atherosclerosis risk in patients with XP.

OBJECTIVE

The present study was a systematic review and meta-analysis to elucidate the association of serum lipid profiles and risk of atherosclerotic diseases with XP.

METHODS

We systematically searched for the eligible comparative studies published before April 15, 2019, in the databases of PubMed, Web of Science, Embase, and Cochrane Library. A random-effects model was used to calculate the standard mean difference with 95% confidence interval for each pooled estimate.

RESULTS

The qualitative analyses included 15 case-control studies with 854 patients with XP. Compared with the controls, the patients with XP had significantly higher serum levels of total cholesterol and low-density lipoproteins, significantly higher apolipoprotein B levels, and relatively lower apolipoprotein A1 levels, and the carotid intima-media thickness was significantly higher.

CONCLUSION

Patients with XP had significantly higher serum levels of atherogenic low-density lipoproteins and bore significantly higher risk of atherosclerosis than the controls. Careful monitoring and targeted intervention for prevention of cardiovascular diseases is essential for these patients.

Treatment of Xanthelasma Palpebrarum using Pulsed Dye Laser: Original Report on 14 Cases

Xanthelasma palpebrarum, a benign xanthoma occurring around the eyes, are treated using lasers like carbon dioxide, argon, pulsed dye, YAG, and diode(1450) laser .Several studies on PDL for xanthelasma palpebrarum (XP) have been reported from abroad but as per our knowledge there are no Indian studies in this regard. We report the efficacy of pulsed dye laser in the management of xanthelasma palpebrarum in Indian patients.

Diagnosis of Familial Hypercholesterolaemia on First Sight? The Role of the Ophthalmologist in Identifying Patients with Familial Hypercholesterolaemia

Familial hypercholesterolaemia (FH) is the most common congenital metabolic disorder characterised by the accumulation of lipid particles in the vascular wall thereby leading to premature development of atherosclerosis. It is a serious condition that, if left untreated, can lead to premature death in a cardiovascular event already in the third or fourth decade of life. According to recent studies, the frequency of heterozygotes in the general population is 1: 250, suggesting that there may be up to 40,000 of these patients in the Czech Republic alone. In terms of capturing FH, the Czech Republic belongs to the most successful countries in the world; however, most patients remain undiagnosed. It is essential that these individuals be actively sought for and manifestation of cardiovascular disease (CVD) prevented. There is a therapeutic option that is effective, safe and affordable. The MedPed (Make early diagnosis to Prevent early deaths) project network and a large number of physicians involved in the project represent an effective approach to the diagnosis and treatment of patients with FH. Even though a large proportion of patients with FH are asymptomatic until the manifestation of CVD, it is possible to diagnose FH using a biochemical examination together with a family history. In some patients, it is also possible to identify clinical signs of the disease. Typical ophthalmologic findings include arcus lipoides corneae and xanthelasma palpebrarum. While these are non-specific symptoms, especially if they occur in patients under 50 years of age, they should prompt examination of lipid spectrum parameters. Every patient with (or suspected) familial hypercholesterolaemia should be referred to one of the workplaces of the MedPed project network. Key words: familial hypercholesterolaemia, MedPed, atherosclerosis, xanthelasma palpebrarum, arcus lipoides corneae.

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.

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.

Xanthelasma Palpebrarum with Arcus Cornea: A Clinical and Biochemical Study

Background:

Xanthelasma palpebrarum (XP) is characterized by sharply demarcated yellowish flat plaques on upper and lower eyelids. It is commonly seen in women with a peak incidence at 30–50 years. It is also considered as the cutaneous marker of underlying atherosclerosis along with the disturbed lipid metabolism. XP and corneal arcus are associated with increased levels of serum cholesterol and low-density lipoprotein (LDL) cholesterol.

Aims and Objectives:

To study the clinical pattern of XP, its relationship with lipid profile and association with arcus cornea.

Materials and Methods:

This study was conducted at Department of Dermatology and Opthalmology, between August 2013 and January 2015. Patients with clinical diagnosis of XP who visited skin outpatient department and willing to undergo lipid profile test and eye examination were included in the study. Data regarding demographics, clinical findings, family history, and past history were noted along with the lipid profile details. Data of age-matched healthy controls were taken for comparison. The clinical profile of the participants was presented using frequency and proportions. Gender wise analysis comparing the lipid profile in cases with XP and without XP was done using independent sample t-test.

Results:

Total 49 patients of XP, 81.6% were females. Maximum, 35% patients were among 50–60 years of age and 69.4% were homemakers by occupation. The average lipid values were-cholesterol 210.57 mg%, triglyceride 123.06 mg%. LDL 142.79 mg% and VLDL 30.95 mg% among patients of XP. Arcus cornea was found in 20% cases of XP.

Conclusions:

Patients of XP requires proper investigation at the onset and regular follow-up thereafter for any altered lipid profile and early diagnosis of coronary artery disease.

Cutaneous manifestations of Erdheim-Chester disease (ECD): Clinical, pathological, and molecular features in a monocentric series of 40 patients

BACKGROUND

Erdheim-Chester disease (ECD) is a rare form of non-Langerhans cell histiocytosis with possible cutaneous-specific involvement.

OBJECTIVES

We sought to describe the clinical, pathological, and molecular features of the cutaneous manifestations of 40 patients with ECD identified from a cohort of 123 patients.

METHODS

Confirmed cases of patients with ECD were included in a single-center retrospective observational study. Clinical and pathological cutaneous features were analyzed and BRAF(V600E) mutation was determined.

RESULTS

The most frequent ECD cutaneous manifestations were xanthelasma-like lesions (XLL), which occurred in 31 (25%) patients. Other ECD cutaneous lesions were patches or papulonodular lesions. Mixed form of ECD and cutaneous Langerhans cell histiocytosis presented with crusty papules of the folds in some patients. Compared with classic xanthelasma palpebrarum, ECD XLL pathology more frequently involved the reticular dermis, displayed more multinucleated or Touton cells, and showed less extensive fibrosis. BRAF(V600E) mutation was more frequently detected in patients with cutaneous involvement than in those without (76% vs 52%; P = .005) and constantly found in 10 XLL.

LIMITATIONS

Some clinical data were not available because of the retrospective design of the study.

CONCLUSIONS

XLL are the most frequent cutaneous ECD manifestations and might be targeted both for pathology and determination of BRAF mutational status.

Comparative Study to Evaluate the Efficacy of Radiofrequency Ablation versus Trichloroacetic Acid in the Treatment of Xanthelasma Palpebrarum

Background:

Xanthelasma palpebrarum (XP) is a metabolic disorder involving the eyelids. Radiofrequency(RF) surgery and trichloroacetic acid (TCA) applications have been listed among the procedures for XP, but comparative studies are not available.

Aim:

To compare the efficacy of radiofrequency surgery versus trichloroacetic acid application in the treatment of XP.

Settings and Design:

20 consecutive cases of XP attending dermatology, medicine and endocrinology out-patient departments of M.S. Ramaiah teaching hospital were enrolled for the study. It was an open-label clinical trial conducted in our hospital for a duration of 1 year.

Materials and Methods:

20 consecutive patients conforming to inclusion criteria were selected for the study. For each patient, lesions were treated with radiofrequency ablation on one side and TCA application on the other side.

Results:

RF ablation was done for 12 patients over right eye lesions and 8 patients over the left eye lesions. TCA applications were done for 8 patients over right eye lesions and 12 patients over left eye lesions. 70% of lesions treated with RF ablation had a score of improvement of 4 and 70% of lesions treated with TCA application had a score of improvement of 4, at 4 weeks of follow-up. At four weeks of follow-up 40% in RF group and 15% in TCA group had scarring and 45% in RF group and 30% in TCA group had pigmentation.

Conclusion:

RF ablation as compared to TCA application, required fewer sessions for achieving more than 75% clearance of lesions. However, TCA applications were associated with fewer complications comparatively.

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.