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Objective:To explore the method and effect of blepharoplasty of upper eyelid combined with orbicularis oculi myocutaneous flap in repair of the canthus defect after excision of xanthelasma.Methods:According to the relaxation of the upper eyelid skin and the width of the xanthoma to be removed, the double eyelid line and the peeling line were designed individually, and the myocutaneous flap was removed to repair the inner canthus defect. After resection of the xanthelasma, the orbicularis oculi myocutaneous flap was transferred retrogradely to repair the defect, and then the upper eyelid plasty was performed.Results:During the follow-up of 3-12 months after operation, 13 cases (24 eyes) of the transferred flaps in the inner canthus survived well, the incision scars were hidden, and the double eyelids on both sides were naturally symmetrical.Conclusions:The method of upper eyelid plasty combined with the reverse transfer of orbicularis oculi myocutaneous flap provides more options for the treatment of defects after resection of xanthoma of the inner canthus. The flap survives well, improves the shape of the upper eyelid while completely removing the focus, and avoids complications such as postoperative deformation and obvious scars.
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AIM: To investigate the correlation between xanthelasma palpebrarum(XP)and the genetic factor of hypercholesterolemia and provide a basis for the elucidation of the pathogenesis of xanthelasma palpebrarum.METHODS: A total of 29 patients with XP who treated in the ophthalmology department of Foshan Sanshui District People's Hospital from November 2019 to January 2021 were selected. Peripheral blood was drawn, and the Next Generation Sequencing(NGS)technology was used to detect the genetic mutations of patients, while blood lipids of XP patients were analyzed.RESULTS: Gene mutations were detected in 21 patients with XP, among which 13 cases had hypercholesterolemia and 8 cases had normal cholesterol levels. Genes including STAP1, APOB, LDLRAP1, LDLR, PCSK9 and APOE mutated, and the types of gene mutation included 3-UTR mutation, in-frame deletion, missense mutation, 5-UTR mutation, synonymous mutation, intronic mutation, alternative splice variant, non coding transcript exon variant, and non coding transcript variant.CONCLUSION: There is a correlation between genetic factors of hypercholesterolemia and XP.
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Objective:To determine the clinical efficacy and safety of a fractional CO 2 laser and a 1 064 nm, Q-switched Nd∶YAG laser therapy in the treatment of xanthelasma palpebrarum. Methods:From October 2020 to October 2021, 30 patients (5 males and 25 females) with bilateralxanthelasma palpebrarum of the eyelid were enrolled in the Department of Dermatology, the First Affiliated Hospital of Xiamen University. The age ranged from 38 to 67 (51±7) years. One side was randomly treated with fractional CO 2 laser as the fractional group, and the other side was treated with Q-switch 1 064 nm Nd∶YAG laser as the Q-switch group. The treatment was given every 28 days for 4 times. Before treatment and 1 month after the last treatment, the general pictures were taken to compare the clinical effect. Skin ultrasound was used to measure the difference of tumor thickness before and after treatment. The incidence of adverse reactions, such as local scar, hyperpigmentation or hypopigmentation after inflammation, were recorded. Results:Under general photos, there was statistically significant difference in efficacy scores between the two groups before and after treatment ( Z=-3.082, P<0.05). By comparison of tumor thickness under skin ultrasound, the difference between the two groups before and after treatment was statistically significant ( t=21.60, P<0.05; t=17.29, P<0.05); there was no statistically significant difference between the two groups before treatment ( t=0.46, P=0.650), but there was statistically significant difference between the two groups after treatment ( t=8.41, P<0.001). No serious adverse reactions occurred in both groups. Conclusions:Fractional CO 2 laser or Q-switch 1 064 nm Nd∶YAG laser can safely and effectively improve xanthelasma palpebrarum, in which the effect of fractional CO 2 laser is much better.
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Xanthelasma, also known as Xanthoma or lipid island, is an uncommon gastrointestinal tract (GIT) tumor-like lesion and the stomach is its most frequent location in upper GI lesions, specifically in the gastric antrum, as a single lesion. The pathogenesis appears to be related to healing processes in response to tissue damage provoked by inflammation induced by Helicobacter pylori infection. Many studies have reported that successful H. pylori eradication helps prevent gastric cancer (GC) development. We present a case of a 77 years old patient that showed endoscopic diagnosis of erythematous gastropathy, a gastric antrum xanthelasma and H. Pylori infection. After confirmed H. pylori eradication, the lesion had complete regression. The successful eradication of H. pylori probably led to a total regression of the lesion. Gastric xanthelasma (GX) has been shown to be an independent predictive marker for early GC detection after H. pylori eradication. GX could be a useful marker for predicting the development of gastric cancer.
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Este estudo demonstrou o excelente resultado do tratamento de xantelasma palpebrarum recidivado com laser ablativo. A paciente foi submetida a uma única sessão de laser Érbio: ítrio-alumínio-granada (Fotona®) 2940nm, e registros fotográficos foram realizados com Vectra® H2 2019 antes e após o procedimento. O tratamento com laser mostrou resultados clínicos satisfatórios, boa tolerabilidade álgica, recuperação precoce, quando comparado a procedimentos cirúrgicos, e menor tempo de afastamento das atividades laborais
Case study of exceptional response to treatment of recurrent xanthelasma palpebrarum with an ablative laser. The patient underwent a single session of laser Erbium: Yttrium-aluminum-garnet (Fotona®) 2940 nm, and we performed photographic records with Vectra® H2 2019 before and after the procedure. Satisfactory clinical results were reported, with good pain tolerability and early recovery compared to surgical procedures and, consequently, less time away from work activities.
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@#AIM: To study the single nucleotide polymorphisms(SNPs)of Macrophage Scavenger Receptor 1(MSR1)gene in xanthelasma palpebrarum patients.<p>METHODS: We drew peripheral venous blood from 20 xanthelasma palpebrarum patients and 20 healthy participants. We detected the SNPs of MSR1 gene with Sanger sequencing, examined serum lipids and α-lipoprotein of the patients, and scanned carotid arteries of the patients with color ultrasound. After that, we kept on observation of the participants.<p>RESULTS: There was no significant difference in the SNPs of MSR1 genotype between xanthelasma palpebrarum patients and healthy participants. However, in some patients with carotid atherosclerosis and hyperlipidemia, there were homozygous mutations at S2-SNP1, S5-SNP2 and S5-SNP4 in the exon region of MSR1 gene, which were related to atherosclerosis.<p>CONCLUSION: Xanthelasma palpebrarum is related to SNPs of MSR1 in atherosclerosis.
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Objective Xanthelasma palpebrarum presents a therapeutic and aesthetic challenge because of its high visibility and frequent rate of recurrence with a wide variety of treatments.Many patients were disappointed by an initial unsuccessful treatment and fail to return for further therapy until the problem had become quite conspicuous.So a simple treatment with few side effects and good acceptance remains an important goal.Methods Eleven patients with xanthelasma lesions were treated with the 1540nm erbium:glass laser.We could see erythema and swell around the skin lesion immediately.It needed irradiate again after one month if there was residual lesion.The end point was the lesions completely removed.The therapeutic effect of 1540nm erbium laser,the adverse reaction and the satisfaction of patients were observed.Results All lesions were removed without hyperpigmentation or scarring.Conclusions The 1540 nm erbium:glass laser represents an effective means for treating xanthelasmas with few side effects and good acceptance.
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Background:Gastric xanthelasma is a benign and uncommon lesion with unknown etiology. It has been noted thatatrophic gastritis is frequently seen in patients with gastric xanthelasma. Aims:To investigate the relationship betweengastric xanthelasma and atrophic gastritis and its clinical significance. Methods:A total of 10645 consecutive patients whohad undergone gastroscopy from Apr. 2015 to Mar. 2016 at the Shanxi Provincial People's Hospital were enrolled andanalyzed retrospectively with respect to their demographic,clinical,endoscopic and histological features. Results:Theprevalence of gastric xanthelasma in patients recruited in this study was 2. 9％ . The mean age and prevalence of atrophicgastritis (47. 9％ vs. 16. 6％ )were significantly higher and the gastric atrophy was more severe in patients with gastricxanthelasma than those without (P all < 0. 001). Multivariate Logistic regression analysis revealed that age ≥50 years(adjusted OR =1. 349,95％ CI:1. 042 ～ 1. 747,P = 0. 023)and atrophic gastritis (adjusted OR = 3. 892,95％ CI:3. 076 ～4. 924,P <0. 001)were independently related to the presence of gastric xanthelasma. Likewise,the prevalence ofgastric xanthelasma in patients with atrophic gastritis was significantly higher than those without (7. 9％ vs. 1. 8％ ,P <0. 001). Age- and sex-matched control analysis proved the correlation between gastric xanthelasma and atrophic gastritis(P <0. 001). In addition,multiple xanthelasma was more prevalent in gastric xanthelasma patients with atrophic gastritisthan those without (32. 0％ vs. 13. 8％ ,P <0. 001). Conclusions:Gastric xanthelasma is correlated with age and presenceand severity of atrophic gastritis. Atrophic gastritis might be one of the etiological factors of gastric xanthelasma,and gastricxanthelasma might be an atypical mucosal lesion caused by gastric atrophy.
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OBJECTIVE: To investigate the effectiveness of combined three operations (rotated total upper eyelid skin flap, construction of double eyelid, and "Z" flap epicanthal plasty) for one stage defect repair after resection of xanthelasma palpebrarum with epicanthus. METHODS: Between December 2013 and December 2015, 12 female patients with large xanthelasma palpebrarum and epicanthus underwent rotated total upper eyelid skin flap, construction of double eyelid, and "Z" flap epicanthal plasty for one stage defect repair. The age ranged from 36 to 59 years (mean, 43 years). The course of disease was 3 to 16 years, with an average of 11 years. The initial resection was performed in 6 cases, second resection of residual xanthelasma palpebrarum in 4 cases, and 2 cases had recurrence after resection. The maximum diameter of xanthelasma palpebrarum was 0.5-1.3 cm (mean, 1.0 cm). According to CHE Junmin et al criterion, epicanthus was rated as mild in 7 cases, moderate in 3 cases, and severe in 2 cases. The blood lipid level was in normal range. RESULTS: Primary healing of incision was obtained, and the flaps survived in all patients; no complication occurred. Scar hyperplasia was found in 4 cases at 1 month after operation, and the comprehensive treatment of scar was performed. All patients were followed up for 3 months to 2 years, with an average of 1.5 years. Double eyelid effects were good, and no xanthelasma palpebrarum recurred. CONCLUSIONS: A combination of rotated total upper eyelid skin flap, construction of double eyelid, and "Z" flap epicanthal plasty is an effective operative procedure to repair defect after resection of xanthelasma palpebrarum with epicanthus; and better curve of double eyelid, better shape of endocanthion, and less tension of flap can be got.
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Objective To study the method and effect of subcutaneous pedicle flap based on the orbicularis oculi muscle in the treatment of xanthelasma.Methods According to the situation of xanthelasma and the soft tissues of upper eyelid,two new double-folds eyelid was designed.The soft tissues (including the skin and muscle) between two lines were intended to form a subcutaneous pedicle flap based on the orbicularis oculi muscle.Then,after the excision of xanthelasma from the surface of orbicularis oculi muscle,the flap was transferred to the defected site.Finally,a new double-folds eyelid was made.Results 13 cases with 25 sides were treated with a follow-up period of 3-6 months.All flaps were survived with good functions and the appearance of upper eyelids were satisfactory.Conclusions Subcutaneous pedicle flap based on the orbicularis oculi muscle is a reliable option for the treatment of xanthelasma.It has the advantages of abundant blood supply,convenience and effective.
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A 33-year old Korean man visited our department complaining of single mildly pruritic yellowish flat-topped papule on left upper eyelid. Lipid profile including low density lipoprotein-cholesterol and triglyceride level was above normal range. He remembered that the site was scalded by boiling oil about eight months ago. The patient was diagnosed with xanthelasma palpebrarum (XP) based on the clinical and histopathological findings, including diffuse infiltrate of large, pale-staining cells which have abundant foamy cytoplasm in the dermis. He was treated with CO2 laser ablation followed by application of 70% trichloroacetic acid with wooden stick. After a month, the skin lesion showed moderate improvement with disappearance of yellowish color and flat-topped elevation. So far, case of XP developed after minor trauma has not been reported. This case illustrates that minor trauma could be a trigger factor in the development of the disorder.
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Humans , Cytoplasm , Dermis , Eyelids , Lasers, Gas , Reference Values , Skin , Trichloroacetic AcidABSTRACT
Xanthelasma might be a clinical manifestation of dyslipidemia, a recognized risk factor for coronary artery disease. We investigated the association of apolipoprotein E (APOE HhaI), apolipoprotein B (APOB XbaI and Ins/Del) and LDL receptor (LDLR AvaII and HincII) gene polymorphisms with lipid profiles in 100 Brazilians with xanthelasma and 100 controls. Allele frequencies were similar in both groups. APOE, APOB and LDLR genotypes were not correlated with differences in the serum lipid profile. In individuals with xanthelasma, the APOB D allele was associated with less chance of having increased LDL-cholesterol (O.R. = 0.16, CI95 percent = 0.03-0.94, p = 0.042). In the control group, the APOB X+ allele was associated with less chance of having both increased total cholesterol (O.R. = 0.16, CI95 percent = 0.03-0.78, p = 0.023) and increased LDL-cholesterol (O.R. = 0.10, CI95 percent = 0.02-0.60, p = 0.012). Moreover, there was a significantly higher frequency of control individuals (68 percent) with elevated serum triglyceride levels, compared to patients (48 percent, p = 0.008). On the other hand, triglyceride levels in controls also seemed to be influenced by all other gene polymorphisms studied, an effect that might be enhanced by environmental factors.
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BACKGROUND: Xanthelasma palpebrarum is the most common type of xanthoma. Due to its delicate location near the eye, treatment of xanthelasma palpebrarum is rather difficult. The treatment includes surgical excision, local treatment with chemicals, and various laser therapies. OBJECTIVE: This study was designed to review the various therapeutic modalities and to evaluate the efficacy and safety of bichloroacetic acid (BCA) for the treatment of xanthelasma palpebrarum. METHODS: Nine patients, with a total of 19 xanthelasma lesions, were treated with BCA. The efficacy and safety were assessed over a follow-up period of 6 to 24 months (average, 16 months). RESULTS: All lesions were grossly removed completely with a single treatment and the treatment was well-tolerated by patients. Erythema and oozing were observed in six patients but improved after two weeks' dressing. Xanthelasma palpebrarum recurred in three patients, but the mean size of the recurred lesions was smaller in comparison to the primary lesion. CONCLUSION: BCA is an effective and safe therapeutic modality for xanthelasma palpebrarum. Advantages include simplicity, cost-effectiveness, speed, safety and efficacy.
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Humans , Bandages , Dichloroacetic Acid , Erythema , Follow-Up Studies , Laser Therapy , XanthomatosisABSTRACT
Xanthelasma refers to planar xanthoma that occurs mainly on the eyelids. Lesions typically begin at the inner canthus, where they emanate in an arc like fashion into the medial portions of the upper or lower eyelids. A 75-year-old woman presented with multiple soft, velvety, yellow flat papules and plaques on both eyelids and cheeks. The lesion was diagnosed as xanthelasma histopathologically. We report an unusual case of extensive xanthelasma with normolipidemia.
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Aged , Female , Humans , Cheek , Eyelids , XanthomatosisABSTRACT
BACKGROUND: Xanthelasma palpebrarum does not regress spontaneously, its appearance is often seen as cosmetically disturbing. Treatment of xanthelasma palpebrarum may prove difficult due to its delicate location at the periorbit and sometimes its extensive dimension. Treatments include excision, electrodesiccation, chemical cautery and laser surgery. OBJECTIVE: This study was designed to evaluate the effect of a CO2 laser for the treatment of xanthelasma palpebrarum. METHODS: Twenty patients with a total of 56 xanthelasma lesions, were treated with a CO2 laser. The Follow-up period of observation was between 12 and 84 months. RESULTS: All lesions could be removed completely with a single laser treatment. Only transient pigmental change (hypopigmentation 1/20, hyperpigmentation 1/20) was observed without scarring. 8 patients developed a recurrence of xanthelasma. CONCLUSION: The CO2 laser represents an effective means for treating xanthelasma, but recurrence is common.
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Humans , Cautery , Cicatrix , Follow-Up Studies , Hyperpigmentation , Korea , Laser Therapy , Lasers, Gas , RecurrenceABSTRACT
BACKGROUND: Xanthelasma palpebrarum is the most common cutaneous xanthoma. Although xanthelasma is a type of xanthoma, a half of patients in most series are known to be normolipemic. OBJECTIVE: This study is an attempt to elucidate the clinical and pathologic features of xanthelasma in Korea and to know the clinical significance of xanthelasma, especially suggested role as a marker for hyperlipidemiae and increased risk for cardiovascular diseases. METHOD: Thirty seven cases of xanthelasma were clinially and pathologically analyzed. Incidence of abnomal lipid profiles and cardivascular diseases were compared with those of control group using logistic regression statistics. RESULTS: 1. The incidence of xanthelasma was 0.09% of the total number of dermatologic patients. 2. The ratio between male and female was 1: 1.8 and the mean age was 52.4 years (range;17-71 years). 3. Clinically, it typically presented as yellow or orange papules on the inner canthus of both upper eyelids. 4. The incidences of abnormal lipid profiles(hyperlipidemia and dyslipoproteinemia) are 42.4-44.0%. The levels of total cholesterol and low density lipoprotein-cholesterol were increased significantly. The incidence of the cardiovascular diseases was 16.2%, which was not statistically different from that of control group. 5. Histopathologic findings of 23 cases showed masses of foam cells in the upper dermis accompanied with sparse inflammatory cells and few giant cells. CONCLUSION: Xanthelasma seems to help to identify persons with abnormal lipid profiles which are risk factors of cardiovascular diseases and we recommand examination of lipid profiles in patients with xanthelasma.
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Female , Humans , Male , Cardiovascular Diseases , Cholesterol , Citrus sinensis , Dermis , Dyslipidemias , Eyelids , Foam Cells , Giant Cells , Hyperlipidemias , Incidence , Korea , Logistic Models , Risk Factors , XanthomatosisABSTRACT
Bichloroacetic acid(BCA), one of the chloroacetic acids, is an effective tissue cauterant when used in high concentration. In dermatologic surgery, BCA, in the form of 100% solution, has been used to treat xanthelasma, sebaceous hyperplasia, verrucae, hard and soft corn, seborrheic keratosis, ingrowing nail, cysts. The cauterization with BCA 100% solution can be used with a simpler technique than the surgical excision or electrical cauterization, without complicated appliance such as LASER generators, so the dermatologic surgical technique - BCA chemical cauterization, topical treatment - can be selected as a treatment of choice for many dermatologic conditions in outpatient offices. BCA destroys the barrier function of the epidermis and penetrates deeply through the papillary dermis and then creates the effect in the papillary dermis and reticular dermis. As a result, regeneration of new dermal collagens and a new epidermis occurs. This pharmacologic effect of BCA makes 100% solution of BCA to be used in the treatment of xanthelasma, pigmented nevi, acne scars with good clinical outcomes.
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Humans , Acne Vulgaris , Cautery , Chloroacetates , Cicatrix , Collagen , Dermatologic Surgical Procedures , Dermis , Dichloroacetic Acid , Epidermis , Hyperplasia , Keratosis, Seborrheic , Nevus, Pigmented , Outpatients , Regeneration , Skin Diseases , Skin , Warts , Zea maysABSTRACT
14 patients with xanthelasma palperbraum of the eyelids have been treated with the CO2 laser. The lipomatous yellow plaque are accurately photovaporized in a bloodless field until the lesion is totally eradicated. The operation with the CO2 laser does not depend on a shape, size, position of the lesion. Satisfactory cosmetic results were achived in 13 of 14 patients without significant scarring.
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Carbon Dioxide , Eyelids , Therapeutics , LasersABSTRACT
Xanthelasma palpebrum is the most common type of xanthoma that develops mainly on the inner epicanthus of upper eyelids with symmetrical distribution. The lesion tends to be permanent, progressive and cosmetically disfiguring. The recommended treatment has been surgical excision, local treatment with chemicals, and carbon dioxide laser. All of the mentioned treatment have some disadvantages including scarring, pigmentary change and need for local anesthesia. We describe the treatment of xanthelasma palpebrum with the pulsed dye laser which coagulates the hyperpermeable vessels so that the lipid leakage could be blocked and prevent recurrence and further progression.