Manual fractional carbon dioxide laser for the treatment of xanthelasma palpebrarum: A prospective, multicenter, randomized, split-face controlled trial

Summary: Abstract Body: Background: Xanthelasma palpebrarum (XP), the most common form of cutaneous xanthoma, is a benign condition that significantly affects the aesthetic appearance of patients. Although fractional CO2 laser is an effective and safe treatment for XP, the potential of manual fractional CO2 laser, with its added flexibility, remains underexplored. Objective: To compare the efficacy and safety of manual fractional CO2 laser with automated fractional CO2 laser for XP treatment. Methods: A prospective, multicenter, randomized, evaluator-blinded, split-face controlled trial was conducted in 37 patients with symmetrical bilateral lesions who were randomized to receive either a manual fractional CO2 laser or an automated fractional CO2 laser on each side of the face. Treatment efficacy, patient satisfaction, and adverse events were assessed over five treatment sessions at four-week intervals, with follow-up one month after the final session. Results: At the third session, the number of lesions achieving >75% clearance (score, 4–5) was significantly higher in the manual fractional laser group (60.5%) than in the automated group (31.6%, P=0.001). At the final follow-up, 89.5% and 47.4% of the lesions in the manual group achieved >75% and 100% clearance, respectively, compared to 76.3% and 18.4% in the automated group. Both treatments showed excellent safety with mild and transient adverse effects, patient satisfaction was higher with manual fractional laser therapy, and recurrence rates were slightly lower (22.6% vs.28.6%). Conclusion: The manual fractional CO2 laser offers superior efficacy, comparable safety, and greater patient satisfaction, making it a cost-effective option for XP treatment, especially in resource-limited settings. Yi Zhao¹ 1. Dermatology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China. Clinical Research: Interventional Research