Table 2.
Different modalities of treatment for XPs
| Modality of treatment | Principle | No. of session | Advantage | Side effects |
|---|---|---|---|---|
| Surgical excision [33, 34] | Meticulous percutaneous resection of the lesions followed by direct suture with or without flap | One or revision surgery |
Simple Best for lesion involving deep dermis and muscle Combined with blepharoplasty |
Recurrence, Ectropion Scar contracture Revision surgery |
| TCA peeling (concentration 35–100%) [35–39] | Dissolving lipids and coagulating proteins | 1–12 |
Simple Low-cost Out-patient clinic procedure |
Hypo- and Hyper-pigmentation Scarring Accidental application to the conjunctiva or cornea—atrophy, Koebner-like phenomenon |
| Low/Mid Voltage Radiofrequency [40] | Thermal energy induces vaporization at the cellular level in tissues | Single |
Quick, Inexpensive Relatively safe |
Hypo- and Hyper-pigmentation Pain |
| Cryo-surgery (nitrous oxide) [44, 45] | Ice crystal formation, Cellular dehydration and electrolyte disruption, Thermal shock, Enzyme inhibition or Effect on proteins | 1–21 Cycle |
Easy for application Low risk of adverse effects |
Recurrence, Hypopigmentation Healing is slow Extensive lesions are difficult to treat |
| CO2 laser (ultra pulse) (10,600 nm) [47–50] | Absorbed by the extracellular fluid of tissue cells, leading to non-specific vaporisation | 1–5 Sessions |
Less downtime, High patient satisfaction |
Hyperpigmentation, scaring, recurrence |
| Erbium:YAG laser (2940 nm) [51–55] | Absorption by water-containing tissues | Single | Suitable for early lesion |
Mild erythema. Hypo- and Hyper-pigmentation |
| Nd:YAG laser (1064 nm) [56–59] | Q-switched—cellular fragmentation via shock waves | Single | Large lesions | Erythema |
| KPT laser (532 nm) [60, 61] | Continuous wave | Single | Safe |
Hypopigmentation, Recurrences |
| Diode laser (1450 nm) [66, 67] | Preferentially targets water | Single | Satisfactory result | Transient focal hyperpigmentation |
| Pulsed dye laser (585 nm) [31, 62] | Vascular specific, targeting small vessels | 5 Sessions | High patient satisfaction | Blisters, crusting and ectropion |
| Intra-lesional Pingyangmycin [73] | A broad-spectrum antitumor antibiotic | 1 Session | Cheap, effective, and safe | No complications |