CO₂ Laser Excision: A Promising Minimally Invasive Treatment for Large Xanthelasma Palpebrarum, Study Finds

"Recurrence occurred in 6.8% of patients, with higher rates observed in lesions larger than 2 mm. Minor complications included scarring (4.4%), hyperpigmentation (8.1%), and hypopigmentation (8.5%), reinforcing its potential as a reliable treatment option," the researchers reported.

Xanthelasma palpebrarum is a common lipid disorder characterized by yellowish plaques on the eyelids. While generally benign, these lesions can be cosmetically distressing and may indicate underlying lipid abnormalities. Traditional treatment methods include surgical excision, chemical peeling, cryotherapy, and electrosurgery, each with its own limitations, such as scarring, pigmentation changes, and recurrence.

Against the above background, Dingqiao Wang, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China, and colleagues aimed to assess the long-term effectiveness and safety of CO₂ laser excision as an innovative approach for treating large xanthelasma palpebrarum.

For this purpose, the researchers included 295 patients diagnosed with xanthelasma palpebrarum, categorizing them into 246 with grade I, 16 with grade II, 22 with grade III, and 11 with grade IV lesions. All patients underwent CO₂ laser excision and were monitored for 12 months. Treatment efficacy was determined based on clearance and recurrence rates, assessed through digital photography, while complications were documented.

Key Findings:

• The study included 66 male and 229 female participants, with an average age of 41.7±11.6 years.
• Clearance rates were over 99% for grades I-III and approximately 95% for grade IV lesions.
• The overall recurrence rate was 6.8%, with significantly higher recurrence in lesions over 2 mm in height than those under 2 mm.
• Complications during the 12-month follow-up included scarring (4.4%), hyperpigmentation (8.1%), and hypopigmentation (8.5%), with no severe adverse events reported.

The researchers highlight CO₂ laser excision as a precise, minimally invasive, and effective treatment for large xanthelasma palpebrarum lesions, marking a significant advancement in therapeutic approaches. Their findings demonstrate high efficacy, particularly for extensive lesions, with clearance rates exceeding 95%, a low recurrence rate of 6.8%, and minimal complications such as scarring, hyperpigmentation, and hypopigmentation.

"By employing laser technology for precise excision, this method presents notable advantages over conventional treatments. However, we acknowledge limitations, including the study’s single-centre, retrospective design and follow-up duration, necessitating future multicentre trials to validate these findings and refine treatment protocols," the researchers concluded.

Reference:

Wang D, Mao Z, Li Z, Gao W, Qu Y, Li X, Jiang Y, Lin X. Carbon dioxide laser excision as a novel treatment for large xanthelasma palpebrarum: long-term efficacy and safety. Br J Ophthalmol. 2025 Feb 24;109(3):427-432. doi: 10.1136/bjo-2024-325581. PMID: 39237290.