Treatment of Xanthelasma palpebrarum with a fractional ablative 2910-nm erbium-doped fluoride glass fiber laser

Xanthelasma palpebrarum (XP) is the most common type of cutaneous xanthoma and may be associated with an underlying systemic hyperlipidemia. Dermal deposition of lipid particles can lead to cosmetically distressing waxy plaques of the upper and lower eyelids that are often recurrent and challenging to manage. Currently, no standard-of-care treatment exists, though managing underlying hyperlipidemia, if present, is typically recommended. To date, there are only two published studies of XP treated with fractionally ablative erbium lasers. Here, we present a retrospective case report of a 54-year-old female of Fitzpatrick skin type III who achieved 95% clearance of XP with fractional ablative resurfacing using 2910-nm erbium laser (UltraClear; Acclaro Medical) with a single pass at 40–60 μm and 50–70% coverage for 3 treatments at two-month intervals. She experienced no adverse events, and transient post-treatment swelling and erythema resolved after 5–7 days. In conclusion, fractional laser ablation with this 2910-nm erbium laser presents an effective treatment option for XP. Notably, a series of treatments may be needed given the fractionated nature of the device, superficial wavelength, and varying thickness of XP plaques.