A comparative study of the efficacy of an ultra-picosecond laser versus an ultra-pulsed CO2 laser in the treatment of xanthelasma palpebrarum.

Objectives: To compare the efficacy and safety of the ultra-pulsed carbon dioxide (CO₂) laser and ultra-picosecond laser in managing Xanthelasma palpebrarum (XP).

Methods: This retrospective study included 230 XP patients treated from February 2021 to June 2024. Among them, 120 patients received ultra-pulsed CO₂ laser treatment, and 110 received ultra-picosecond laser treatment. Treatment effectiveness was assessed based on lesion clearance rate, recurrence, Vancouver Scar Scale (VSS) scores, and safety profiles, with a focus on complications such as scarring and pigmentary changes.

Results: Both lasers achieved high clearance rates (> 95%), with no significant difference between the two groups (83.33% in the ultra-pulsed CO₂ laser group vs. 80.00% in the ultra-picosecond laser group, P = 0.513). However, the ultra-picosecond group required more treatment sessions (4.74 ± 0.56 vs. 3.26 ± 1.32, P < 0.001) but had a lower recurrence rate (6.36% vs. 15.00%, P = 0.036). The ultra-pulsed CO₂ laser group showed a higher incidence of hypertrophic scarring (8.33% vs. 1.82%, P = 0.026) and pigmentary complications (hyperpigmentation: 11.67% vs. 2.73%, P = 0.010; hypopigmentation: 10.83% vs. 3.64%, P = 0.037). A significant difference in erythema incidence was also observed (40.00% vs. 27.27%, P = 0.042). Patient satisfaction levels with the two treatments were comparable (P > 0.05).

Conclusions: Both laser therapies were effective in treating XP. However, the ultra-picosecond laser demonstrated superior safety, with fewer complications and lower recurrence rates, despite requiring more treatment sessions.