Management of Adult-onset Eyelid Xanthogranuloma: Debulking Surgery Coupled with Intralesional Corticosteroids

Abstract

Introduction: Adult-onset xanthogranuloma (AOX) is a rare, benign inflammatory disorder within the spectrum of non-Langerhans cell histiocytosis, often manifesting as localised skin lesions in middle-aged adults and frequently misdiagnosed due to its nonspecific presentation.

Case: A 43-year-old woman developed a painless, progressively enlarging mass on her right upper eyelid over four months, with histopathology confirming AOX.

Observation: Following surgical debulking and adjunctive intralesional corticosteroid (triamcinolone acetonide) injection, the patient exhibited significant clinical improvement and no recurrence at three months. This outcome supports emerging evidence that a combination of surgery and corticosteroid therapy effectively reduces lesion size and recurrence rates in localised AOX.

Conclusion: The multimodal approach combining surgical excision and intralesional corticosteroid injections provides a conservative and effective management strategy for AOX, with favourable outcomes and minimal complications. Further research is warranted to standardise treatment protocols for this rare orbital disease.