Clinical and dermoscopic assessment of ablative carbon dioxide laser versus intradermal heparin sodium in xanthelasma.

Abstract

Background: Ablative carbon dioxide (CO₂ ) laser is still a cornerstone in the management of xanthelasma. However, post-laser complications such as post-inflammatory hyperpigmentation or scarring have to be considered. Heparin sodium was recently suggested as an effective therapeutic modality for xanthelasma.

Objective: The aim of this work was to compare the therapeutic value of ablative CO₂ laser versus intradermal heparin sodium in xanthelasma.

Methods: This study was piloted on 30 xanthelasma patients, whose lesions were randomly categorized into two groups. Group A was managed with CO₂ laser ablation (2 sessions scheduled every 4 weeks), whereas Group B was managed with intradermal heparin sodium injections (10 sessions scheduled every week). Pre- and post-treatments evaluations were done both clinically and dermoscopically.

Results: Significant reduction of xanthelasma lesions was reported in response to both therapeutic interventions. However, the ablative CO₂ laser was more significantly effective than intradermal heparin sodium. Interestingly, intradermal injection of heparin sodium was nearly as effective as ablative CO₂ laser in early (<2 years duration) grade I and II xanthelasma, with a lower incidence of post-therapy side effects.

Conclusions: Intradermal injection of heparin sodium could be suggested as a safe and cost-effective therapeutic technique for early mild grade I and II xanthelasma. Moreover, it could be recommended as a pre-operative management of grade III and IV xanthelasma to reduce the lesions to be easily ablated with CO₂ laser.