From the Guidelines
Xanthelasma management involves both cosmetic procedures and addressing underlying causes, with first-line treatments including surgical excision, laser therapy, chemical cauterization, or cryotherapy to remove the yellowish cholesterol deposits around the eyes, as recommended by recent studies 1.
Key Considerations
- The most common location of xanthelasma is around the eyes, but it can also occur on the face, neck, and other areas 1.
- Chemical cauterization with trichloroacetic acid (70-100%) can be an effective treatment option, but should be applied carefully by a dermatologist 1.
- Laser treatments, such as CO2 or pulsed dye lasers, typically require 1-3 sessions spaced 4-6 weeks apart 1.
- If hyperlipidemia is present, lipid-lowering medications such as statins (e.g., atorvastatin 10-80mg daily or rosuvastatin 5-40mg daily) should be prescribed 1.
- Lifestyle modifications, including a low-cholesterol diet, regular exercise, weight management, and smoking cessation, are essential components of treatment 1.
Important Notes
- Recurrence is common (approximately 40% within 4 years), especially if underlying lipid abnormalities aren't controlled 1.
- Patients should understand that while cosmetic procedures improve appearance, managing cholesterol levels is crucial for preventing recurrence and reducing cardiovascular risk, as xanthelasma can be a visible marker of dyslipidemia even when lipid panels appear normal 1.
- The diagnosis and evaluation of adult patients with histiocytic neoplasms, including Erdheim-Chester disease, Langerhans cell histiocytosis, and Rosai-Dorfman disease, should be based on a multidisciplinary approach, including dermatology, endocrinology, hematology, laboratory medicine, neurology, pathology, pulmonology, radiology, and rheumatology 1.
From the Research
Xanthelesma Management Options
- Surgical excision: a common method for treating xanthelasma palpebrarum, especially for lesions involving the deep dermis and/or muscle 2
- Laser ablation: carbon dioxide laser ablation has shown significant clinical efficacy and tolerability in the treatment of xanthelasma palpebrarum 3
- Chemical cauterization: trichloroacetic acid (TCA) peeling is a effective treatment option, with 70% TCA peeling showing more significant clinical efficacy and tolerability than 50% and 35% TCA peeling 3, 4
- Cryotherapy: liquid nitrogen cryotherapy is a commonly cited treatment option 5, 6
- Radiofrequency: used in the treatment of xanthelasma palpebrarum 6
Treatment Outcomes
- TCA peeling 70% and carbon dioxide laser ablation have shown high efficacy and tolerability with least number of sessions in the treatment of xanthelasma palpebrarum 3
- Simple excision has a low recurrence rate of 3.1% and a low rate of major complications or disfigurement 2
- Hypopigmentation and hyperpigmentation are common side effects of TCA peeling 3, 4
- Scarring is a minor problem with TCA peeling 4
Factors Affecting Treatment Outcome
- Lipid profile: patients with normal lipid profile show significant improvement in treatment outcome compared to those with abnormal lipid profile 3
- Lesion type: papulo-nodular lesions require an average of two applications with 100% TCA, while flat plaques and macular lesions respond to an average of 1.43 and 1 application with 100% TCA, respectively 4