Xanthelasma is the most common type of xanthoma in the periorbital region with clinical diagnosis. About 50% of patients have hypercholesterolemia in laboratory tests - inferring clinical importance to this condition. We aim to report a case of a 55-year-old female patient presenting yellowish papules on the upper eyelids diagnosed as Xanthelasma. She had hypercholesterolemia and type II diabetes in use of rosuvastatin 10mg and metformin 1000mg. She complaint of significant aesthetic discomfort that affected her interpersonal activities. It was performed intralesional electrosurgery with good outcome. The procedure starts with asepsis and antisepsis followed by local anesthetic button with 2% lidocaine and adrenaline. Next the xanthelasma is punctured with the same anesthesia needle leaving a small portion exposed so that there is contact with the electrocautery. The radiofrequency is applied to the needle that works as an intralesional conductor of energy, always using the lowest frequency capable of generating whitening of the xanthelasma - which denotes denaturation of lipids. Finally, the needle is removed and the procedure is concluded with the patient being instructed to use ointment with retinol acetate 10,000 IU, amino acids 25mg, methionine 5mg and chloramphenicol 5mg in vehicle: methylparaben, propylparaben , cetyl alcohol, lanolin, solid petroleum jelly and microcrystalline wax (trade name Epitezan or Regencel) twice daily for 14 days. The proposed treatment had good aesthetic results, low cost and complexity, good pain tolerance and short recovery time. The disease has few treatment options available and among them the intralesional electrosurgery does not require technologies, has low cost and good aesthetic results.

Xanthelasma is the most common type of xanthoma in the periorbital region with clinical diagnosis. The collection of lipids in the superficial and deep dermis causes lesions with slow growth that in such an evident site cause aesthetic discomfort to patients.
The prevalence is estimated at 4% with an incidence of 1.1% in women and 0.3% in men. About 50% of patients have hypercholesterolemia in laboratory tests - inferring clinical importance to this condition.
We aim to report a case of a 55-year-old female patient presenting yellowish papules on the upper eyelids diagnosed as Xanthelasma. She had hypercholesterolemia and type II diabetes in use of rosuvastatin 10mg and metformin 1000mg. She complaint of significant aesthetic discomfort that affected her interpersonal activities.
It was performed intralesional electrosurgery with good outcome. The procedure starts with asepsis and antisepsis followed by local anesthetic button with 2% lidocaine and adrenaline. Next the xanthelasma is punctured with the same anesthesia needle leaving a small portion exposed so that there is contact with the electrocautery. The radiofrequency is applied to the needle that works as an intralesional conductor of energy, always using the lowest frequency capable of generating whitening of the xanthelasma - which denotes denaturation of lipids. Finally, the needle is removed and the procedure is concluded with the patient being instructed to use ointment with retinol acetate 10,000 IU, amino acids 25mg, methionine 5mg and chloramphenicol 5mg in vehicle: methylparaben, propylparaben , cetyl alcohol, lanolin, solid petroleum jelly and microcrystalline wax (trade name Epitezan or Regencel) twice daily for 14 days. The patient was evaluated after the procedure was performed in 30, 90 and 120 days.
The disease has few treatment options available and even today, scientific evidence is limited regarding the best protocol. The intralesional electrosurgery had good aesthetic results, low cost and complexity, good pain tolerance and short recovery time.

ESDR629 - Intralesional electrosurgery of eyelid xanthelasma: a case report

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