Efficacy of Trichloroacetic Acid Versus Cryotherapy in Patients with Xanthelasma Palpebrarum: A Randomized Controlled Trial

Trichloroacetic Acid vs. Cryotherapy for Xanthelasma

Abstract

Xanthelasma palpebrarum is a common benign eyelid lesion with multiple treatment options. Objectives: To compare the efficacy and safety of 100% trichloroacetic acid (TCA) versus cryotherapy in its management. Methods: A randomized controlled trial was conducted at the Department of Dermatology, Nishtar Hospital, Multan, from November 2024 to April 2025. Sixty patients with untreated bilateral xanthelasma palpebrarum were enrolled using non-probability consecutive sampling and randomly assigned using a computer-generated simple randomization technique (1:1) to receive either 100% trichloroacetic acid or cryotherapy. Treatment efficacy and adverse effects were evaluated at six weeks using standardized clinical criteria. Data were analyzed using SPSS version 26. A confidence level of 95% was used for all statistical analyses. Results were considered statistically significant at a p-value≤0.05. Results: A total of 60 patients (30 patients in each group) with xanthelasma palpebrarum were enrolled, with a mean age of 40.10 ± 7.40 years and a mean disease duration of 11.18 ± 2.94 months. Females comprised 60.0% of the sample, and 63.3% were aged 36–55 years. Excellent treatment response was observed in 53.3% of patients treated with 100% TCA and 20.0% with cryotherapy (p=0.023). Hyperpigmentation (p=0.020) and scarring (p=0.010) were significantly higher in the TCA group. Age, gender, and lesion location showed no significant association with efficacy or adverse effects. Conclusions: TCA offers superior clinical efficacy compared to cryotherapy but with a higher risk of adverse cosmetic effects, underscoring the need for individualized treatment planning in xanthelasma management.