Fibroxantoma atípico: caso clínico / Scalp atypical fibroxanthoma: report of one case

Atypical Fibroxanthoma is an unusual dermal mesenchymal tumor. It especially affects older adults and occurs in areas of sun exposure. We report a 75 years old male with a history of sun exposure without using a hat presenting with a scalp nodule. An incisional biopsy showed an atypical fibroxantoma. In a new surgical procedure, the tumor was completely excised. The tumor relapsed in two occasions after subsequent excisions and the patient was treated with adjuvant radiotherapy avoiding new relapses.

CO2 Laser Treatment of Xanthelasma Palpebrarum in Skin Types III-IV: Efficacy and Complications After 9-Month Follow-Up.

Objective: Ultrapulse CO2 laser has been used for several decades for removal of xanthelasma lesions. However, most studies to date have focused on Caucasian patients (skin types I-II). We sought to assess the efficacy and complications of CO2 laser therapy for xanthelasma palpebrarum (XP) in Chinese patients (skin types III-IV). Methods: Data of 38 patients with xanthelasma who received CO2 laser treatment between December 2013 and January 2016 at our hospital were retrospectively analyzed. Patients were followed up for 9 months. Results: Recurrence occurred in 19/38 (50%) patients. Recurrence was significantly more common in patients with multiple lesions (15/24; 62.5%) than in patients with single lesions (4/14; 28.6%). At 3 months after treatment, the complication rate was 63.16%. The complications included hypopigmentation (23/24; 95.8%) and scarring (1/24; 4.2%). In all patients, the hypopigmentation had disappeared by end of the 9-month follow-up. Conclusions: Ultrapulse CO2 laser appears to be capable of completely removing XP in patients with medium skin type III-IV. The most common complication is hypopigmentation, but this resolves with time.

[Scalp atypical fibroxanthoma. Report of one case]. / Fibroxantoma atípico. Caso clínico.

Atypical Fibroxanthoma is an unusual dermal mesenchymal tumor. It especially affects older adults and occurs in areas of sun exposure. We report a 75 years old male with a history of sun exposure without using a hat presenting with a scalp nodule. An incisional biopsy showed an atypical fibroxantoma. In a new surgical procedure, the tumor was completely excised. The tumor relapsed in two occasions after subsequent excisions and the patient was treated with adjuvant radiotherapy avoiding new relapses.

Treatment of xanthelasma palpebrarum with a 1064-nm, Q-switched Nd:YAG laser.

BACKGROUND: Xanthelasma palpebrarum is the most common cutaneous xanthoma characterized by soft, yellow papules or plaques that arise on the periorbital skin. As these lesions can be cosmetically disfiguring, many patients seek medical help to remove these lesions. OBJECTIVE: To determine the effectiveness and minimum number of treatment sessions with a 1064-nm, Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser for the treatment of xanthelasma. METHODS: A retrospective review of patients with xanthelasma consecutively treated with Q-switched Nd:YAG laser was conducted. Forty-six patients with 103 lesions were identified from January 2012 through August 2015. Photographs taken of patients immediately before treatment and 4-8 weeks after treatment were independently evaluated by 2 dermatologists. RESULTS: After a single treatment session, 93.2% of lesions had some degree of clearance. All lesions had excellent-to-complete clearance after at least 4 treatment sessions. Patients usually required 4 treatment sessions for optimal results. LIMITATIONS: This was a retrospective study. Treatment parameters varied, follow-up periods were not uniform, and response was not assessed with a validated scale. CONCLUSION: The Q-switched Nd:YAG laser is effective and well tolerated in the treatment of xanthelasma in our study population.

A prospective study comparing ultrapulse CO2 laser and trichloroacetic acid in treatment of Xanthelasma palpebrarum.

BACKGROUND: Xanthelasma Palpebrarum is a type of xanthoma which presents as cosmetic concern. OBJECTIVE: To compare the efficacy of 30% TCA and UpCO2 laser in XP. METHODS AND MATERIALS: Fifty patients with XP were categorized clinically into three groups. Patients in each group were alternately allocated to 30% TCA (Group A) and laser (Group B). TCA was applied weekly (maximum: 12 sessions), and laser sessions were given monthly (maximum: three sessions). The primary outcome measures were total patients cured, the number of sessions, and mean VAS at the end of treatment. The secondary outcome measures were total duration of treatment, side effects, and recurrence in follow-up (6 months) (P < 0.05 significant). RESULTS: In Group A, 14 of 25 and in Group B, 25 of 25 patients achieved complete cure (P < 0.05). The mean VAS was lower for Group A (patient: 4.56 vs. 5.36; physician: 4.64 vs. 5.44) [P < 0.05] with significant difference only for group III patients. Mean number of sessions was less with laser group (1.56 vs. 9.74), except in group I. There was no significant difference in pigmentary changes and recurrence. CONCLUSION: For clinically mild lesions, both TCA and laser are good options, but laser is a better option for severe lesions. Recurrence is a concern with both modalities.

Fractional CO2 laser is an effective therapeutic modality for xanthelasma palpebrarum: a randomized clinical trial.

BACKGROUND: Xanthelasma palpebrarum (XP) is a common cosmetic concern. Although there is a wide range of therapeutic modalities for XP, there is no general consensus on the optimal treatment for such condition. OBJECTIVE: Compare the efficacy and safety of super pulsed (SP) and fractional CO2 lasers in the treatment of XP. PATIENTS AND METHODS: This prospective randomized comparative clinical study included 20 adult patients with bilateral and symmetrical XP lesions. Xanthelasma palpebrarum lesions were randomly assigned to treatment by either single session of ablative SP CO2 laser or 3 to 5 sessions of ablative fractional CO2 laser with monthly intervals. All patients were assessed using digital photography and optical coherence tomography images. RESULTS: Xanthelasma palpebrarum lesions on both sides were successfully removed with significant improvement in size, color, and thickness. Although lesions treated by SP CO2 laser showed significantly better improvement regarding color and thickness of the lesions, downtime and patient satisfaction were significantly better for lesions treated with fractional CO2 laser. Scarring and recurrence were significantly higher in lesions treated by SP CO2 laser. CONCLUSION: Ablative fractional CO2 laser is an effective and safe therapeutic option for XP with significantly shorter downtime and higher patient satisfaction compared with SP CO2 laser.

Failure of radiation therapy in orbital xanthogranuloma.

PURPOSE: The efficacy of radiation therapy in orbital xanthogranuloma in patients who fail medical therapy is unclear. The purpose of this study was to ascertain its effectiveness. METHODS: The records of 11 cases were reviewed retrospectively for histopathologic findings, age, gender, site of involvement, clinical manifestations, and outcomes of treatment. The case histories of the 4 patients treated with radiation, all of whom had failed medical treatment, were described. RESULTS: Of 11 patients, 5 were female, and all were white. The age range at the time of presentation was 25 to 85 years. Nine patients had bilateral involvement. Five patients, all of whom had bilateral disease, had systemic manifestations or autoimmune disease thought to be related to their orbital disease. In general, patients treated with systemic corticosteroids had at least a partial response of their lesion. However, none of the 4 patients treated with orbital radiation (3 of whom had not responded to steroid treatment and 1 of whom had responded only to high-dose steroids) experienced improvement, and at least 3 experienced exacerbation of their disease. The histologic features before treatment in all cases were similar and consistent with xanthogranuloma. CONCLUSION: Orbital xanthogranuloma may be a unilateral or bilateral condition. Particularly when bilateral, it may be associated with similar lesions elsewhere or with systemic autoimmune disorders. The results of this study suggest that fractionated radiotherapy not only may be ineffective but also may exacerbate the progression of the orbital lesions in patients who do not respond to medical therapy or who are steroid dependent on intolerable doses of medication.

Eruptive neutrophilic xanthomas.

Cutaneous eruptive xanthomas are characteristics lesions of hyperlipidemia. Rarely,these lesions may present with prominent leukocytoclasis as seen in papular neutrophilic xanthomas, which have been described in HIV positive and immunocompromised patients. Herein we describe a patient with eruptive neutrophilic xanthomas with neither hyperlipidemia nor immunocompromise. Moreover, these lesions improved with sun and UV light exposure.

Treatment of xanthelasma palpebrarum using a pulsed dye laser: a prospective clinical trial in 38 cases.

BACKGROUND: Several studies have reported positive results of nonablative laser treatment of xanthelasma palpebrarum, but the published evidence is weak and inconclusive. OBJECTIVE: To systematically evaluate the effect of pulsed dye laser (PDL) treatment of xanthelasmas. MATERIALS AND METHODS: Twenty female Caucasian patients with 38 lesions (< or =1 mm above skin level) were enrolled. They received up to five treatment sessions with a PDL (wavelength, 585 nm; energy fluence, 7 J/cm(2); pulse duration, 0.5 ms; spot size, 10 mm; number of passes, 2) at 2- to 3-week intervals. Photographs were taken before each treatment session and 4 weeks after the last treatment. Two independent examiners categorized clearance into four groups (no clearance [<25% xanthelasma area(s) cleared], moderate [25-50%], good [51-75%], and excellent [>75%]). Patient satisfaction was assessed on a verbal rating scale. RESULTS: Approximately two-thirds of the lesions showed clearance greater than 50%, and one-quarter had clearance greater than 75%. Interrater reliability was excellent (contingency coefficient >0.7 at all visits). Treatments were well tolerated and had no major side effects. Patient satisfaction was generally high. CONCLUSION: PDL is a promising approach for treating xanthelasmas, especially when multiple sessions are performed.

Is Q-switched neodymium-doped yttrium aluminium garnet laser an effective approach to treat xanthelasma palpebrarum? Results from a clinical study of 76 cases.

BACKGROUND: Treating xanthelasma palpebrarum may prove difficult because of its delicate location on the eyelid. Various forms of nonablative laser techniques have been examined, and Q-switched neodymium-doped yttrium aluminium garnet (Nd:YAG) laser therapy has shown promising preliminary results. OBJECTIVES: To determine the efficacy of Q-switched Nd:YAG laser treatment for xanthelasma removal. MATERIALS AND METHODS: Thirty-seven consecutive patients with 76 lesions received two treatment sessions with a Q-switched Nd:YAG laser without local anesthesia (6 J/cm(2) [1,064 nm] or 2 J/cm(2) [532 nm], 4-mm spot size, 2-3 passes). Photographs were taken before each treatment session and 4 weeks after the second treatment. Two independent examiners rated clearance in four groups (none [<25% cleared], moderate [25-50%], good [51-75%], and excellent [>75%]). RESULTS: Only two-thirds of the patients completed the entire course of the study; disappointing early results were the main reason for dropping out. The majority of treated lesions (70% or 75%, depending on the examiner) showed no clearance. Plasma low-density lipoprotein cholesterol levels displayed some influence on treatment results but not enough to facilitate stratification of patients. CONCLUSION: Q-switched Nd:YAG (532 nm and 1,064 nm) laser treatment of xanthelasma cannot be recommended.

Necrobiotic xanthogranuloma associated with lymphoplasmacytic lymphoma. Palliative treatment with carbon dioxide laser.

Necrobiotic xanthogranuloma (NXG) with paraproteinemia is a rare non-x histiocytosis with conspicuous lesions mainly located on the periorbital skin. A 68-year-old woman, with a previous history of lymphoplasmacytic lymphoma associated with IgG monoclonal gammopathy over a period of almost 4 years, presented typical lesions of NXG on the periorbital regions and left buttock. Treatment with dioxide carbon laser resulted in great improvement of cutaneous lesions, and no evidence of relapse after a 12-month follow-up. The association of NXG with lymphoplasmacytic lymphoma has not been previously described to our knowledge. The treatment of these lesions represents a true challenge for the clinician and palliative treatment of cutaneous lesions of NXG with CO(2) laser may constitute an alternative treatment in selected cases.