Xanthelasmas are yellowish papules or plaques caused by the deposition of lipid on or around the eyelids. Xanthelasma palpebrarum (XP) is the most common cutaneous presentation.They present as soft symmetrical, bilateral, yellow, thin polygonal papules and plaques typically in the periorbital area.
Lesions typically appear in females more than males, between 40 and 60 years but may appear at younger ages as a sign of a familial dyslipoproteinemia. Approximately 50% of patients with xanthelasmas have abnormal cholesterol or triglyceride levels.
Lesions are typically asymptomatic and treatment is often sought for cosmetic purposes.
■Treatment Options:
Systemic Therapy:
It aims at treatment of hypercholesterolemia and atherogenesis.
•Antioxidant e.g. Probucol
•Anticholesterol therapy e.g. Alirocumab.
Topical therapy:
•Chemical Peel:
Topical TCA is a form of destructive therapy. It is more effective for smaller lesions, with repeated procedures resulting in pigmentation and scarring.
•Liquid nitrogen cryotherapy
It is a simple and effective treatment option with the risk of intense swelling due to the lax skin tissue in the eyelid
•Pingyangmycin
Intralesional pingyangmycin, a broad-spectrum antitumor antibiotic may be used.
Energy-based devices:
•Radio-frequency ablation:
(RF) ablation is effective particularly in multiple lesions and lesions close to the eye.
•Laser ablation:
Laser ablation has been used to deliver targeted therapy in the treatment of XP.
Advantages of lasers include better acceptance, avoidance of surgery, minimal tissue loss, good functional and cosmetic results, and therapy repeatability.
*CO2 laser:
It is considered the gold-standard ablative laser with excellent outcome.
*Er:YAG laser:
It is a purely ablative laser with less risk of scarring. It also has the added advantage of faster healing time, shorter duration of postlaser erythema, and postinflammatory hypo- and hyperpigmentation.
*Q-switched Nd:YAG laser
*Argon laser
*Potassium titanyl phosphate laser
*Pulsed dye laser
*Diode laser
Plasma-based Devices:
e.g. Plasmage, Plasma Jet and Plexr are new treatment options for xanthelasma.
Electrodessication using Hyfrecator.
Surgery:
Surgical excision is the traditional treatment option for XP. It often yields excellent cosmetic outcomes.
The classic blepharoplasty may be used in a serial staged approach.
Combined approach e.g. a combination approach of surgery and chemical peeling.