Comparative Study for Treatment of Normolipidemic Xanthelasma Using Ablative CO2 Laser with Intralesional Injection of Platelet Rich Fibrin versus its Topical Application

Background: Xanthelasma palpebrarum is a benign lesion with significant cosmetic impact and therapeutic challenges. Fractional CO₂ (FCO₂) laser has been used successfully, though with limitations. Platelet-rich fibrin (PRF), a novel platelet concentrate with anti-inflammatory properties, may enhance healing. Aim: To compare intralesional PRF injection versus topical PRF membrane application following ablative FCO₂ laser in bilateral normolipidemic xanthelasma. Patients and Methods: Thirty patients with bilateral xanthelasma (60 lesions) underwent ultra-pulsed ablative CO₂ laser. Lesions were randomized into two groups: group A (30 lesions) treated with topical PRF membrane and group B (30 lesions) with injectable PRF fluid. Clinical evaluation and sequential photographs were recorded before and at 1, 3, and 6 months post-treatment. Results: Baseline characteristics were comparable between groups. Both methods produced significant cosmetic improvement with no recurrence at one-year follow-up. Group B (injectable PRF) demonstrated better, though statistically non-significant, improvement compared to group A. Only one patient developed a keloid scar after intralesional PRF. Conclusion: Ablative FCO₂ laser followed by either topical or injectable PRF is safe and effective for normolipidemic xanthelasma. Injectable PRF provided relatively superior outcomes, but both modalities achieved excellent healing and sustained clearance, offering a promising therapeutic approach.