Comparison of efficacy and safety between intralesional injection of heparin sodium and CO2 laser ablation in the treatment of xanthelasma

[Objective] To evaluate the clinical efficacy and safety of intralesional injection of heparin sodium versus carbon dioxide (CO2) laser ablation in the treatment of xanthelasma palpebrarum. [Methods] A total of 38 patients with Grade Ⅰ-Ⅲ xanthelasma and normal blood lipid levels were retrospectively enrolled, and divided into two groups based on the treatment modality: the heparin sodium group (n=20) treated with intralesional injection of heparin sodium and the CO2 laser group (n=18) treated with CO2 laser ablation. The primary and secondary outcomes were compared between the two groups, including the therapeutic effect at 1 week post-treatment, the recurrence rate at 3 months, the incidence of adverse events during treatment and follow-up, and patient satisfaction. [Results] There was no significant difference in the overall therapeutic effect between the two groups (P=0.107). All patients in the CO2 laser group achieved excellent response (100%), while 80.00% of patients in the heparin sodium group achieved excellent response, and 20.00% achieved good response. Regarding patient satisfaction, the satisfaction rate was higher in the heparin sodium group than in the CO2 laser group (100% vs. 83.33%, P=0.023). For adverse events, the incidence of scar formation (72.22%) and hypopigmentation (33.33%) in the CO2 laser group was significantly higher than that in the heparin sodium group (both P<0.01). In contrast, the incidence of hyperpigmentation in the heparin sodium group was higher than that in the CO2 laser group (60.00% vs. 5.56%, P<0.001), and most cases of hyperpigmentation spontaneously resolved or improved within 6 months. No statistically significant difference was observed in the recurrence rates between the two groups (P=0.663). [Conclusions] Intralesional injection of heparin sodium for xanthelasma offers comprehensive advantages, including “definite efficacy, no risk of scarring, and high treatment satisfaction,” making it a potentially viable alternative for treating xanthelasma.