Fractional CO₂ laser versus trichloroacetic acid 50% for xanthelasma palpebrarum therapy

Abstract

Xanthelasma palpebrarum (XP), which is the commonest form of xanthomas, is presented as soft, yellowish papules or plaques which appear mainly near the upper eyelids. 1 It is cosmetically disfiguring and may be an important sign of the underlying primary or secondary dyslipoproteinemia. 2 Histologically, xanthelasma represents the deposition of foam cells associated with fibroproliferative tissue in the middle and superficial layers of the dermis around the vessels and adnexal structures. 3 Many techniques have been applied for xanthelasma therapy, involving surgical excision, ablative and nonablative lasers as CO 2 , erbium and Q-switched Nd: YAG, ablation by radiofrequency, and chemical peeling. However, side effects are reported with these techniques. 4-9 The carbon dioxide (CO 2) laser has been applied in many modes like a continuous, superpulsed, and ultrapulsed mode for the ablation of XP, with reported variable incidence of recurrence and adverse events. 2,5 Fractional CO 2 laser, working with theory of selective photothermolysis and creating microthermal treatment zones (MTZs), surrounded by areas of viable epidermis and dermis. So, the healing process is more rapid and with less risks than conventional CO 2 laser. 10 Trichloroacetic acid peeling has a wide range of applications, being simple technique with low cost, but can result in pigmentary disorders and scarring especially with use of higher

Endolesional ablation of xanthelasma using microfiber optic laser delivery

“…The use of flat-beamed traditional lasers in the 1450 and 1470 nm range is not new and is already documented to lead to acceptable outcomes and relatively lower downtimes. 16 Heat-induced destruction of sebaceous glands is likely accountable for the efficacy of 1450 nm lasers, apocrine hydro cystoma, and possibly appendigeal tumors. 17,18 As an extension of this idea we explored the use of 1470 nm microfiber optic delivery in an attempt to reduce downtimes and potential for side effects in situations where there was no viable alternative, in an attempt to deliver thermal energy directly intralesionally, reduce the port of entry, associated complications and downtime associated with epithelial loss.…”