There is no established go-to, long-term cosmetic solution for xanthelasmas, and recurrence happens often with current treatment modalities, according to an update on xanthelasma treatments, recently published in the Journal of Cutaneous and Aesthetic Surgery.
Xanthelasmas are benign and rarely cause functional issues, yet the localized lipid deposits on the eyelids can be a cosmetic concern for some, as well as an indication of an underlying plasma lipid disorder in about half of those who have the lesions.
The authors performed a literature search on xanthelasma and found a scarcity of strong evidence for treatment options. But those treatments that were commonly cited included topical trichloroacetic acid (TCA); liquid nitrogen cryotherapy; and lasers, including carbon dioxide, Er:YAG, Q-switched Nd:YAG, and pulse dye laser. They found providers also used surgical excision to rid patients of the yellowish papules and plaques.
Researchers found that successful treatment has been reported with the systemic therapy probucol, an antioxidant, with one study showing 68% of xanthelasma regressed post probucol therapy.
Studies looking at TCA peels for xanthelasma treatment suggest TCA 70% is the most effective concentration.
“Overall, TCA therapy for [xanthelasma] was found to be more effective for smaller lesions, with repeated procedures resulting in pigmentation and scarring,” according to the paper.
Providers might avoid using liquid nitrogen cryotherapy to treat xanthelasma because of the risk of intense swelling. But one study showed that using liquid nitrogen cryotherapy with a very short freeze time cleared lesions, with minor associated swelling, for a decade.
Radiofrequency (RF) ablation has been effective for treating the lesions in a couple of studies. Nine of 15 patients achieved a greater than 75% improvement of xanthelasmas in one study. Another suggested that while fewer RF treatments might be required to treat the lesions, compared to TCA therapy, RF has more complications.
Among the lasers with some evidence of successful xanthelasma treatment, is the CO2, which is considered the gold-standard ablative laser for this indication, the authors write, although treatment with the Er:YAG laser seems to have a lower risk of scarring and faster healing time than the CO2.
On the other hand, benefits using the 1064-nm Q-switched Nd:YAG laser for xanthelasma are not clear, according to the paper.
Studies show good outcomes and safety with use of argon laser coagulation of xanthelasma, but recurrence is high.
Surgical excision, using various approaches, has yielded positive results.
“The authors advocate that surgical excision should be the mainstay of treatment for [xanthelasma] lesions that involve the deep dermis or infiltrate the underlying muscle,” they write.