Perla Nº2: Xantelasma tratado con heparina

Perlas dermatológicas
Numero 2

Treatment of xanthelasma palpebrarum with intralesional heparin sodium: a pilot study.
Azendour H, Alami S, Meziane M, Ismaili N, Benzekri L, Senouci K.Int J Dermatol. 2023 Mar;62(3):e124-e125. doi: 10.1111/ijd.16509. Epub 2022 Nov 13

Treatment of xanthelasma palpebrarum with intralesional heparin sodium: a pilot study Dear Editor, Xanthelasma palpebrarum (XP) refers to xanthomas that occur around the eyelids. They are usually asymptomatic, and cosmetic reasons are the main purpose for their removal. The technique has been dropped for centuries, until its recent reintroduction for treating XP.4. Intradermal injections using a solution of heparin sodium at a concentration of 25.000 U/5 ml were performed. The solution was injected using an insulin syringe with a 30G 13 mm fixed needle, and it was slowly injected until bleaching from fluid load extended 1–2 mm above the limits of xanthelasma lesion.

For each session, the amount of solution infiltrated in both sides never exceeded 1 ml, which means 5.000 UI of heparin sodium per session.

At this amount, we believe that the risk of an

adverse effect from a systemic passage is extremely low. However, a reflux maneuver was always done before infiltration to avoid an intravascular injection.

The study included 14 patients, of whom five were diagnosed with Grade I XP, two with Grade II, and seven with Grade III. The mean age at diagnosis was 49 years, and 13 (92.8%) were female.

. In total, 12 patients completed the study, and treatment outcomes were scored as 3 in nine patients (75%), and 2 in three patients (25%) (Figs. 1 and 2). No patient failed to have any improvement. Nine patients experienced varying degrees of periorbital ecchymosis, and two presented a transitory pigmentation. No patient presented a recurrence during follow-up. Perception of pain was different between patients, ranging from 0 to 9 according to the visual analog scale for pain, with a mean of 4.9.

• Cornbleet T. Local action of heparin on xanthomas. AMA Arch Derm. 1955;71:172–6. https://doi.org/10.1001/archderm.1955. 01540260030006
• Ren J, Zeng LY, Chen MH. Treatment of Grade I and II types of xanthelasma palpebrarum with intralesional heparin sodium. Dermatol Ther. 2018;31:e12723. https://doi.org/10.1111/dth. 12723