AT LASER 2017
SAN DIEGO (FRONTLINE MEDICAL NEWS) – Laser treatments may be effective for xanthelasma palpebrarum lesions, based on a systematic review of existing studies, although the research is limited.
“The number of cases we looked at was relatively small, so you can’t come up with any definite conclusions,” said review coauthor Christopher J. Huerter, MD, head of the division of dermatology at Creighton University, Omaha. “But it’s promising since the lasers we examined all work with some efficacy, with the CO2 and Er:YAG [erbium:YAG] lasers probably having the best results.”
Xanthelasma lesions appear as small yellowish plaques on the eyelids. “About half the people who have it have some blood lipid abnormality,” Dr. Huerter said in an interview. “If a person has it, it’s worthwhile to do a cholesterol screen or a lipid profile.”
The lesions often appear in middle-aged people. According to Dr. Huerter, they’re typically only a cosmetic problem. “Some people have a pretty mild case. And for some others, it’s pretty noticeable. It bothers them, and they want something done about it,” he said.
Treatment with trichloroacetic acid is one option, although it was more common before lasers began to be used. In addition, “surgical incision can be very effective,” he said, although the review notes that it can create undesirable scarring.
Researchers have studied laser treatment for xanthelasma for at least 30 years. Dr. Huerter and his colleagues examined 21 studies published since 1987, with the following lasers: CO2 laser (three studies), argon laser (one study), Er:YAG laser (four studies), ultrapulse CO2 laser (five studies), 1,450-nm diode laser (one study), pulsed dye laser (PDL, two studies), superpulsed or fractional CO2 laser (one study), and Q-switched neodymium:YAG laser (three studies). An additional study examined both argon and Er:YAG lasers.
The number of treated patients in the studies ranged from 1 to 50, and the number of treated lesions ranged from 1 to 76. (Patients often had more than one lesion.) “It would be nice to have bigger studies and bigger numbers,” Dr. Huerter said at the annual meeting of the American Society for Laser Medicine and Surgery.
Although the studies were limited by small cohorts, short follow-up, and lack of comparison groups, the findings did reveal signs of effectiveness: Clearance rates were 100% in CO2, argon, and PDL cases and about 85% with Er:YAG lasers. Clearance rates were lower with Nd:YAG (about 55%) and 1,450-nm diode (about 48%) lasers.
Edema was reported in all PDL cases and erythema in almost 20% of CO2 cases. Dyspigmentation was most common – at about 30% – in Er:YAG and 1,450-nm diode cases. Visible scars were reported in more than 5% of Er:YAG cases.
The review concluded that “sufficient evidence is available to suggest laser therapies to be a cosmetically excellent treatment option for xanthelasma , particularly applicable in patients who are not good candidates for surgical excision,” he said.
As for advice to dermatologists, Dr. Huerter pointed to the positive results for CO2 and Er:YAG lasers. He said PDL lasers could also be used. As for argon lasers, he noted that it’s not as likely for dermatologists to have them on hand, he said.
In regard to choosing which xanthelasma lesions to treat with laser, he said thicker ones may not be as amenable. “But if you do laser treatment and don’t get the results you want, you can always excise.”
No funding for the study was reported. Dr. Huerter reported no disclosures.