Xanthelasmas, yellowish fatty deposits around the eyelids, can be treated in various ways depending on the severity and preference of the patient. Different forms of treatment are described here:

Medical Treatments

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1. Intralesional Sodium Heparin
– Method: Intralesional injections of sodium heparin.
– Efficacy: Preliminary studies have shown significant reductions in the size and appearance of xanthelasmas with minimal side effects.

2. Intralesional Bleomycin
– Method: Injection of bleomycin directly into the lesions.
– Efficacy: This treatment has shown promising results in the reduction of xanthelasmas.

Laser Treatments

1. Erbium laser (Er:YAG)
– Method: It uses a wavelength of 2940 nm, highly absorbed by water, ideal for vaporization and ablation of skin tissues.
– Effectiveness:
– Results: Effective in the removal of xanthelasmas with minimal risk of scarring. Comparative studies have shown that Er:YAG has a shallower depth of penetration, reducing the risk of thermal damage to surrounding tissues.
– Advantages: High precision, less damage to adjacent tissues, shorter recovery time, and fewer side effects such as post-inflammatory hyperpigmentation.
– Disadvantages: May require several sessions to completely remove xanthelasmas, especially if they are deep or extensive.

2. CO2 Laser (Carbon Dioxide)
– Method: It uses a wavelength of 10,600 nm, allowing precise and effective ablation, with the ability to perform precise cuts and simultaneous coagulation.
– Effectiveness:
– Results: Highly effective for the removal of xanthelasmas, providing complete removal in a single session in most cases. The depth of penetration allows treatment of deeper and more extensive lesions.
– Advantages: High efficacy in the complete elimination of lesions, reduced bleeding due to simultaneous coagulation, and lower risk of recurrence.
– Disadvantages: Increased risk of scarring and post-treatment pigmentation changes. Requires specialized operator skills to minimize risks.

Comparison between Erbium Laser and CO2 Laser
– Precision: The erbium laser provides greater precision and control in the ablation of the surface, making it ideal for more superficial lesions.
– Depth of Penetration: The CO2 laser has a greater depth of penetration, beneficial for treating deeper and more extensive lesions.
– Recovery Time: The erbium laser generally offers faster recovery time and fewer side effects such as scarring and pigmentation changes.
– Side Effects: Both lasers can cause side effects, but the CO2 laser has a higher risk of scarring and pigmentary changes due to its greater penetration and thermal effect.

Other Laser Treatments

1. 1064 nm Nd:YAG Laser
– Method: Use of laser to remove fat deposits.
– Efficacy: Effective in the removal of xanthelasmas, although it may require multiple sessions and has a risk of scarring.

2. Pulsed Diode Laser
– Method: Use of pulsed laser to treat lesions.
– Efficacy: Effective in several cases, with risk of post-inflammatory hyperpigmentation.

Surgical Treatments

1. Surgical Extirpation
– Method: Surgical removal of xanthelasmas.
– Efficacy: Traditional method that offers immediate results, although it may leave scars.
– References: Historically used as an effective treatment.

2. Plasma Ablation
– Method: Use of plasma technology to vaporize fat deposits.
– Efficacy: Recent methods have shown positive results with less risk of scarring.

Pharmacological Treatments

1. Statins and Other Hypolipidemic Agents
– Method: Use of drugs to reduce blood cholesterol levels.
– Efficacy: May help in the prevention of new xanthelasmas and in the reduction of existing xanthelasmas in patients with dyslipidemias.

General Considerations

– Choice of Treatment: It will depend on the extent of xanthelasmas, patient preference, tolerance to possible side effects and availability of treatments.
– Follow-up: Post-treatment follow-up is crucial to assess efficacy and detect possible recurrences or side effects.

These treatments offer various options for managing xanthelasmas, and the choice of one or the other will depend on the specific situation of each patient.

At MMG we offer you different therapeutic options to treat xanthelasmas. Request your consultationnow

References:

1. Azendour et al., 2022 on Intralesional Sodium Heparin:https://piel-l.org/perla-no2-xantelasma-tratado-con-heparina

2. Intralesional Bleomycin, Intralesional Pingyangmycin, Plasma Ablation, and Statins and Other Hypolipidemic Agents: https://www.springermedizin.de/examining-treatment-strategies-for-xanthelasma-palpebrarum-a-comprehensive-literature-review-of-contemporary-modalities

3. 1064 nm Nd:YAG and Pulsed Diode Laser: https://www.springermedizin.de/examining-treatment-strategies-for-xanthelasma-palpebrarum-a-comprehensive-literature-review-of-contemporary-modalities

4. Surgical excision:
Examining treatment strategies for xanthelasmas palpebrarum: a comprehensive review of contemporary modalities:https://www.springermedizin.de/examining-treatment-strategies-for-xanthelasma-palpebrarum-a-comprehensive-literature-review-of-contemporary-modalities

5.Examining treatment strategies for xanthelasma palpebrarum: a comprehensive literature review of contemporary modalities: https://link.springer.com/article/10.1007/s00403-024-02863-y