Background: Xanthelasma palpebrarum (XP) is the most common cutaneous xanthoma. It is a 
benign lesion that appears as yellowish plaque near the inner canthus of the eyelid. There is still 
paucity of strong evidence for the single best effective treatment of XP. Objective: The aim of this 
study was to assess the clinical efficacy and tolerability of once application of two concentrations of 
topical trichloroacetic acid (TCA) (30% versus 70%) in treatment of patients with XP. Methods: This 
randomized clinical trial was conducted on patients presenting to Occuloplastic Clinic at Tanta
University Eye Hospital. Patients with Soft and semisolid xanthelasma lesion at upper or lower 
eyelids were included. Forty patients were randomly distributed into 2 groups: Group 1 treated by 
once application of 30% TCA and Group 2 treated by once application of 70% TCA. Results: There 
was a statistically significant (p<0.001) improvement in group 2 compared to group 1. Excellent 
results where the skin of the lesion returned normal as the rest of the surrounding skin were 
significantly higher in group 2 (94.1%) than group 1 (14.7%). Group 2 showed absence of significant 
(p>0.05) association between the clinical outcome and the number, type, or size of the lesion. There 
was a statistically significant (p<0.001) increase in lid erythema in group 2 compared to group 1
(45.0% versus 0.0%, respectively). Conclusion: A single session peeling with TCA 70% was highly 
effective than TCA 30% in the treatment of xanthelasma palpebrarum patients whatever the number, 
type, or size of lesion. The only significantly reported side effect was lid erythema.