Clinical and experimental dermatology · 2026
Efficacy and safety of surgical excision vs. 70% trichloroacetic acid topical application in xanthelasma palpebrarum: a split-face randomized clinical trial.
СтатьяРандомизированное исследованиеСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Kumar Sheetanshu, Kumari Rashmi, Behera Geeta, Ramassamy Sivaranjini, Somasundaram Arun, Meena Akshay, Agrawal Akriti, Mohapatra Devi Prasad
Аннотация
BACKGROUND: Despite its frequency, there is a lack of comparative evidence evaluating available treatment modalities for xanthelasma palpebrarum (XP). Although surgical excision and trichloroacetic acid (TCA) are commonly used interventions for XP, no study has compared these two modalities.
OBJECTIVES: To compare the efficacy and safety of surgical excision vs. 70% TCA in the management of limited XP.
METHODS: A prospective, split-face, single-blinded, single-centre randomized clinical trial conducted from November 2024 to August 2025 with a 12-week follow-up. Adults aged ≥ 18 years with bilateral XP limited to ≤ one-third of the palpebral area were included. Key exclusion criteria were lesions larger than one-third of the eyelid height or area and lesions within 2 mm of the canthi. These criteria ensured safe and comparable use of both treatments. Each participant contributed two XP units (XPUs, defined as all XP lesions in one eye). One eye XPU in each patient was randomized to surgical excision and the contralateral eye XPU to TCA application (up to three sessions, 4 weeks apart). The primary outcome was complete clearance (100% reduction in XPU surface area) at week 12. Secondary outcomes included cosmetic outcome, patient satisfaction, percentage reduction in size and adverse effects. The trial is registered with the Clinical Trials Registry of India, no. CTRI/2024/10/074929.
RESULTS: All excision-treated XPUs (36/36; 100%) achieved complete clearance compared with 8/36 XPUs (22%) treated with TCA (McNemar test; P < 0.001). The median percentage reduction was 100% for excision and 69.2% for TCA (P < 0.001, Wilcoxon signed-rank test). Excellent cosmetic outcomes occurred in 21/36 (58%) excised XPUs vs. 1/8 (13%) TCA-treated XPUs that achieved complete remission. Dyschromia was more common after TCA (27/36, 75%) than excision (15/36, 42%). Older age independently predicted excellent cosmetic outcomes after surgical excision with receiver operating characteristic analysis identifying 51 years as the optimal cutoff. Papulonodular morphology was associated with TCA treatment failure.
CONCLUSIONS: Surgical excision was more effective than 70% TCA for limited XP, providing predictable single-session clearance, superior cosmetic outcomes, fewer pigmentary changes and higher patient satisfaction. Excision can be considered the preferred first-line therapy for localized XP.
OBJECTIVES: To compare the efficacy and safety of surgical excision vs. 70% TCA in the management of limited XP.
METHODS: A prospective, split-face, single-blinded, single-centre randomized clinical trial conducted from November 2024 to August 2025 with a 12-week follow-up. Adults aged ≥ 18 years with bilateral XP limited to ≤ one-third of the palpebral area were included. Key exclusion criteria were lesions larger than one-third of the eyelid height or area and lesions within 2 mm of the canthi. These criteria ensured safe and comparable use of both treatments. Each participant contributed two XP units (XPUs, defined as all XP lesions in one eye). One eye XPU in each patient was randomized to surgical excision and the contralateral eye XPU to TCA application (up to three sessions, 4 weeks apart). The primary outcome was complete clearance (100% reduction in XPU surface area) at week 12. Secondary outcomes included cosmetic outcome, patient satisfaction, percentage reduction in size and adverse effects. The trial is registered with the Clinical Trials Registry of India, no. CTRI/2024/10/074929.
RESULTS: All excision-treated XPUs (36/36; 100%) achieved complete clearance compared with 8/36 XPUs (22%) treated with TCA (McNemar test; P < 0.001). The median percentage reduction was 100% for excision and 69.2% for TCA (P < 0.001, Wilcoxon signed-rank test). Excellent cosmetic outcomes occurred in 21/36 (58%) excised XPUs vs. 1/8 (13%) TCA-treated XPUs that achieved complete remission. Dyschromia was more common after TCA (27/36, 75%) than excision (15/36, 42%). Older age independently predicted excellent cosmetic outcomes after surgical excision with receiver operating characteristic analysis identifying 51 years as the optimal cutoff. Papulonodular morphology was associated with TCA treatment failure.
CONCLUSIONS: Surgical excision was more effective than 70% TCA for limited XP, providing predictable single-session clearance, superior cosmetic outcomes, fewer pigmentary changes and higher patient satisfaction. Excision can be considered the preferred first-line therapy for localized XP.