Xanthelasma palpebrarum: Treatment with the ultrapulsed CO2 laser

Abstract

Background and Objective: Due to its delicate location near the eye and the high recurrence rate, the therapy of xanthelasma palpebrarum is a difficult surgical task. Besides chemical, physical, and surgical procedures, various laser systems have been used to treat these lesions (argon laser, pulsed dye laser, and CO2 laser). This study was designed to critically evaluate the use of the ultrapulsed CO2 laser for the treatment of xanthelasma palpebrarum. Study Design / Materials and Methods:We report about the standardized treatment of 23 patients (52 periorbital xanthelasmas) and the results obtained after one treatment with a new generation, ultrapulsed CO2 laser (COHERENT Ultrapulse 5000C, Palo Alto, CA; 250-500 mJ; 600-900 µsec; 10,600 nm). The followup time was 10 months. Results: All lesions could be removed completely with a single laser treatment. As for side effects, only transient pigmental changes (4% hyperpigmentations, 13% hypopigmentations) and no visible scarring was observed. Three patients (13%) developed a recurrence of xanthelasma. Conclusions:The ultrapulsed CO2 laser is an effective and safe therapeutic alternative to the hitherto described approaches.

Treatment of Xanthelasma Palpebrarum by the Pinhole Method Using a 10,600-nm Carbon Dioxide Laser

“…6 However, the penetration depths of individual laser devices are limited according to their device-specific wavelengths, and repetitive treatments are frequently required. 2 Moreover, because nonablative laser devices are not widely used in many clinics, the cost-effectiveness of new laser devices for treatment of XP remains to be evaluated.…”

“…1 To date, several studies have reported on the therapeutic efficacies of ablative and nonablative lasers for XP, including 10,600-nm carbon dioxide (CO2) lasers, erbium-doped yttrium aluminum garnet (YAG) lasers, 1,550-nm erbium-doped fractional lasers, pulsed dye lasers, Q-switched neodymium (Nd):YAG lasers, and 1,450-nm diode lasers. [2][3][4][5][6] The pinhole method using a CO2 laser refers to a procedure in which multiple small holes mimicking sweat pores are made on skin lesions, such as burn scars and syringomas. 7,8 Puncturing the targeted skin lesions with the pinhole method is easy to perform and results in less oozing and post-therapy erythema.…”

Erbium:Yttrium Aluminum Garnet Laser Treatment for Xanthelasma Palpebrarum

“…Xanthelasmas start in the reticular dermis or subdermis and progress to the subcutaneous layer and orbicularis oculi muscle. Various treatment options are available including excision, 4,5 trichloroacetic acid (TCA) peeling, 6,7 cryotherapy, argon laser, 8 CO2 laser, 9,10 and Nd:YAG laser therapy. 11,12 Small lesions can be effectively treated by surgical excision.…”

“…16 In the mid-1990s, the ultra-pulsed CO2 laser was developed for skin lesion removal, and it can be applied for less than 1 msec for effective vaporization with high fluency. 9 At first, we performed surgical excision to remove xanthelasmas; then, we changed to the ultrapulsed CO2 laser; and now, we use an Er:YAG laser. The water absorption coefficient of Er:YAG laser energy is 10 times greater than that of CO2 laser energy.…”

“…Various treatment options for xanthelasma palpebrarum are available, including surgical excision, 4,5 chemical peeling, 6,7 cryotherapy, argon laser, 8 carbon dioxide (CO2) laser, 9,10 and neodymium:yttrium aluminum garnet (Nd:YAG) laser. 11,12 However, the results thereof are generally suboptimal and involve high recurrence rates.…”