高能量CO2点阵激光与点阵射频治疗萎缩性痤疮瘢痕的自身对照研究

目的 评价高能量CO₂点阵激光和点阵射频治疗萎缩性痤疮瘢痕的疗效及安全性。方法 随机分配半脸进行治疗,一侧使用DeepFx CO₂点阵激光,另一侧使用点阵射频。第一遍单点治疗凹陷痤疮瘢痕,第二遍全部痤疮瘢痕区域扫描。每次治疗间隔2个月,5次治疗结束后随访3个月,采用4分位数评分量表评价痤疮瘢痕改善情况,并观察并发症情况。结果本组共28例患者,治疗后两侧痤疮瘢痕改善无显著差异,CO₂点阵激光治疗侧色素沉着显著高于点阵射频治疗侧,CO₂点阵激光治疗时疼痛明显低于点阵射频治疗。两侧均未出现永久性色素改变和瘢痕。结论 高能量CO₂点阵激光和点阵射频均能有效改善萎缩性痤疮瘢痕,无永久性不良反应,均可作为痤疮瘢痕的治疗选择。     

二氧化碳点阵激光联合硅凝胶瘢痕贴片治疗面部痤疮瘢痕疗效观察

目的:观察二氧化碳点阵激光联合硅凝胶瘢痕贴片治疗面部痤疮瘢痕的临床疗效与复发性。方法:采用二氧化碳点阵激光治疗160例面部痤疮瘢痕患者,将患者随机分为治疗组及对照组,均治疗5个周期。治疗组同时辅助采用硅凝胶瘢痕贴片治疗,对照组单纯应用二氧化碳点阵激光治疗,并对两组有效率及痤疮瘢痕复发率进行分析。结果:治疗组有效率(86.25%)较对照组(71.25%)高,两组间差异有统计学意义(P0.05);门诊随访3~6个月,治疗组复发率(5.00%)明显低于对照组(12.50%),两组间差异有统计学意义(P0.05)。结论:二氧化碳点阵激光联合硅凝胶瘢痕贴片治疗面部痤疮瘢痕,疗效确切、复发率相对较低。     

点阵激光治疗痤疮后萎缩性瘢痕的系统评价

目的:探讨点阵激光治疗痤疮后萎缩性瘢痕的疗效和安全性。方法:计算机检索中英文数据库,手工检索相关杂志及学术会议论文集。收集所有点阵激光治疗痤疮后萎缩性瘢痕的随机对照试验,采用Cochrane协作网推荐的方法作系统综述。结果:共纳入11个研究。结果显示,点阵激光治疗痤疮后萎缩性瘢痕有效,与点阵射频相比,差异无统计学意义,但点阵射频的不良反应较轻。点阵激光的疗效与安全性均优于化学换肤。与传统激光和微针治疗相比,点阵激光疗效较优,但安全性较差。结论:点阵激光是治疗痤疮后萎缩性瘢痕的有效方法,但临床应用的确切有效性和安全性尚需更多的随机对照试验证实。     

点阵二氧化碳激光联合微创瘢痕松解治疗痤疮后萎缩性瘢痕的临床效果

目的探讨点阵二氧化碳激光联合微创瘢痕松解治疗痤疮后萎缩性瘢痕的临床效果。方法采用回顾性观察性研究方法。2021年1—6月, 河南中医药大学第一附属医院接诊60例符合入选标准的3、4级痤疮后萎缩性瘢痕患者。根据采用的治疗方法, 将点阵二氧化碳激光联合微创瘢痕松解治疗的30例患者纳入联合治疗组[男19例、女11例, 年龄(26±4)岁], 将单纯点阵二氧化碳激光治疗的30例患者纳入单纯激光组[男18例、女12例, 年龄(25±6)岁], 每2个月治疗1次, 共3次。首次治疗前及末次治疗后2个月, 对瘢痕进行痤疮瘢痕临床评分量表(ECCA)评分;末次治疗后2个月, 根据ECCA评分行疗效评价并计算治疗总有效率。记录患者治疗过程中的不良反应发生情况。对数据行独立样本t检验、Wilcoxon秩和检验、Mann-WhitneyU检验、χ2检验、Fisher确切概率法检验。结果首次治疗前, 2组患者ECCA评分相近(P>0.05);末次治疗后2个月, 联合治疗组患者ECCA评分明显低于单纯激光组(Z=-2.89, P<0.05)。联合治疗组、单纯激光组患者末次治疗后2个月ECCA评分均较...     

超脉冲二氧化碳点阵激光治疗痤疮瘢痕的临床观察

目的：探讨超脉冲二氧化碳点阵激光治疗皮肤痤疮瘢痕的疗效和安全性。方法：本试验对26名痤疮瘢痕患者进行点阵激光治疗,并分别于术前、术后7天、术后1个月、术后3个月分别进行数码照相、无创皮肤检测、记录恢复过程和副作用。通过前后对比,观察临床效果和副作用。医生对治疗效果进行4级评分,患者对疗效的满意率也进行4级评分。结果：超脉冲二氧化碳点阵激光是痤疮瘢痕的有效治疗手段。术后3个月,80.8%的患者改善率超过50%;92.3%的患者达到满意或非常满意的效果。     

超脉冲二氧化碳点阵激光治疗萎缩性瘢痕疗效观察

目的:观察超脉冲二氧化碳点阵激光治疗萎缩性瘢痕的临床疗效并总结经验。方法:60例不同成因的萎缩性瘢痕患者,根据患者的皮肤Fitzpatrick分级、瘢痕的深浅度及瘢痕所在部位设定合适的能量参数,采用超脉冲CO_2点阵激光治疗,每3个月治疗1次,共4次。根据医生和患者的满意度疗效评价标准分别对治疗2次、4次后的疗效进行评估。结果:60例患者,治疗2次、4次的总有效率分别为86.7%和100%,治疗效果与治疗次数呈正相关。结论:超脉冲CO_2点阵激光治疗萎缩性瘢痕安全、有效,有效率和治疗次数密切相关。     

基于温哥华瘢痕量表评分的强脉冲光联合二氧化碳点阵激光序贯治疗深度烧伤后早期增生性瘢痕的效果

目的探讨强脉冲光与二氧化碳点阵激光联合的序贯治疗深度烧伤后早期增生性瘢痕的效果。方法采用回顾性队列研究, 选择2019年5月至2021年1月郑州市第一人民医院收治的符合入选标准的深度烧伤后早期增生性瘢痕患者为研究对象。患者均在创面愈合后4～8周开始接受序贯治疗, 根据每次治疗前温哥华瘢痕量表(VSS)评分选择治疗方式, 若血管分布≥2分, 厚度<2分, 则给予强脉冲光治疗;若血管分布≥2分, 厚度≥2分, 则给予强脉冲光联合二氧化碳点阵激光治疗;若血管分布<2分, 厚度≥2分, 则给予二氧化碳点阵激光治疗;若血管分布<2分, 厚度<2分, 则治疗结束。强脉冲光治疗每个月1次, 二氧化碳点阵激光治疗每3个月1次。患者治疗前、治疗结束后采用VSS、观察者瘢痕评估量表(OSAS)和患者瘢痕评估量表(PSAS)进行疗效评估, 评分越高表明瘢痕越严重。记录患者治疗期间强脉冲光及二氧化碳点阵激光治疗次数, 患者治疗结束时瘢痕形成时间及并发症发生情况。使用SPSS 22.0软件进行统计分析, 计量资料数据采用±s表示, 采用配对样本t检验进行患者自身治疗前后的比较。结果共纳入...     

美容缝合联合剥脱性二氧化碳点阵激光治疗颌面部增生性瘢痕的效果观察

目的:本研究旨在探讨美容缝合联合剥脱性二氧化碳点阵激光对于颌面部增生性瘢痕的临床效果。方法:本研究选取2015年1月至2019年1月在笔者科室接受治疗的158例颌面部增生性瘢痕患者。所有患者均接受了美容缝合联合剥脱性二氧化碳点阵激光治疗,在治疗前和治疗后6个月采用温哥华瘢痕量表(Vancouver scar scale,VSS)、北卡罗来纳大学(the University of North Carolina,UNC)瘢痕量表、患者满意度来评估临床效果。结果:治疗前VSS评分为(9.35±1.82)分高于治疗后6个月的(3.12±1.04)分,治疗前UNC瘢痕量表评分为(8.03±1.45)分高于治疗后6个月的(1.62±0.72)分,差异均有统计学意义(P 0.05)。患者的总体满意率为100%,所有患者均未发生长期并发症。结论:美容缝合联合剥脱性二氧化碳点阵激光能够有效地治疗颌面部增生性瘢痕,效果满意。     

Nd:YAG 1064 nm激光与超脉冲点阵CO2激光治疗面部萎缩性痤疮瘢痕美学效果对比研究

目的：探讨Nd:YAG 1 064 nm激光与超脉冲点阵CO2激光治疗面部萎缩性痤疮瘢痕美学效果。方法：选择2018年1月-2021年1月笔者医院收治的94例患者，按照随机数字表法分为对照组(47例)与研究组(47例)。对照组接受Nd:YAG 1 064 nm激光治疗；研究组接受超脉冲点阵CO₂激光治疗。比较两组临床疗效、愈合时间、误工时间、温哥华瘢痕量表(Vancouver scar scale,VSS)评分及不良反应。结果：研究组治疗总有效率95.74%，较对照组80.85%高(P<0.05)；研究组结痂时间、完全脱痂时间均比对照组短(P<0.05)；研究组治疗后柔软度、色泽、血管分布、厚度评分均低于对照组(P<0.05)；研究组治疗后社会功能、自我感知、痤疮症状评分高于对照组(P<0.05)；两组不良反应总发生率相比无差异(P>0.05)。结论：相比Nd:YAG 1 064 nm激光，超脉冲点阵CO₂激光治疗面部萎缩性痤疮瘢痕可以明显缩短患者愈合时间，更好改善瘢痕，美学效果更佳。     

1064-nm Nd:YAG皮秒点阵激光与超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的临床比较

目的 探究1064-nm Nd:YAG皮秒点阵激光与超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的疗 效与安全性。方法 选取2021年6月-2023年6月于我院激光科接受治疗的62例面部萎缩性痤疮瘢痕患者作 为研究对象,按照不同的治疗方法分为皮秒点阵激光组和CO2点阵激光组,各31例。皮秒点阵激光组给予 1064-nm Nd:YAG皮秒点阵激光治疗,CO2点阵激光组给予超脉冲CO2点阵激光治疗,比较两组ECCA权 重评分、疗效自评分、满意度评分及术后不良反应发生情况。结果 两组治疗后ECCA权重评分均较治疗 前降低（P ＜0.05）,且皮秒点阵激光组的ECCA权重评分高于CO2点阵激光组（P ＜0.05）;CO2点阵激光 组疗效自评分高于皮秒点阵激光组（P ＜0.05）;皮秒点阵激光组不良反应发生情况低于CO2点阵激光组 （P ＜0.05）;两组满意度比较,差异无统计学意义（P＞0.05）。结论 1064-nm Nd:YAG皮秒点阵激光与 超脉冲CO2点阵激光均能有效改善面部萎缩性痤疮瘢痕,超脉冲CO2点阵激光疗效更好,而皮秒点阵激光 不良反应发生情况更少。     

Treatment of Atrophic Facial Scars with Combined Use of High-Energy Pulsed CO2 Laser and Er:YAG Laser: A Practical Guide of the Laser Techniques for the Er:YAG Laser

BACKGROUND: Although CO2 laser resurfacing provides substantial clinical improvement for atrophic facial scars, the CO2 laser often results in excessive thermal damage to the skin. It increases complications postoperatively. The Er:YAG laser ablates thinner layers of tissue than the CO2 laser with minimal thermal damage to the surrounding skin. OBJECTIVE: To determine the efficacy of combined treatment of atrophic facial scars with high-energy pulsed CO2 laser and Er:YAG laser. METHODS: One hundred fifty-eight patients were treated with a combination of high-energy pulsed CO2 laser and Er:YAG laser for atrophic facial scars. All patients were evaluated after 3 months of treatment. RESULTS: The scars improved 80-89% in 65 patients, 70-79% in 56 patients, more than 90% in 32 patients, 60-69% in 2 patients, and less than 60% in 3 patients after laser treatment. CONCLUSION: Treatment of atrophic facial scars with combined use of high-energy pulsed CO2 laser and Er:YAG laser is a very effective and useful method.     

Prolonged Clinical and Histologic Effects from CO2 Laser Resurfacing of Atrophic Acne Scars

BACKGROUND: The recent development of high-energy pulsed CO2 lasers that minimize thermal injury to uninvolved adjacent structures has revolutionized the manner in which atrophic facial scars are recontoured. Significant improvement of atrophic scars with laser resurfacing has clearly been demonstrated; however, the exact timing for assessment of skin for further treatment has varied due to the unknown amount of time needed after laser scar resurfacing to effect maximal collagen formation and remodeling. OBJECTIVE: The aim of this study was to determine the immediate and long-term (12-18 months) histologic and clinical effects of atrophic acne scars after CO2 laser resurfacing in order to provide physician guidelines for postoperative clinical assessment for retreatment. METHODS: Sixty patients (50 women, 10 men, mean age 38 years, skin types I-V) with moderate to severe atrophic facial scars were evaluated. Nineteen patients received regional cheek treatment and 41 patients received full-face resurfacing with a high-energy pulsed CO2 laser. Independent clinical assessments of treated scars were performed at 1, 6, 12, and 18 months and blinded histologic analyses were made of skin biopsies immediately prior to and after laser resurfacing, and at 1, 6, 12, and 18 months postoperatively in six patients. RESULTS: Significant immediate and prolonged clinical improvement in skin tone, texture, and appearance of CO2 laser-irradiated scars was seen in all patients. Average clinical improvement scores were 2.22 (69%) at 1 month, 2.1 (67%) at 6 months, 2.37 (73%) at 12 months, and 2.5 (75%) at 18 months. Continued collagenesis and subsequent dermal remodeling were observed on histologic examination of biopsied tissue up to 18 months after surgery. CONCLUSION: Continued clinical improvement was observed as long as 18 months after CO2 laser resurfacing of atrophic scars, with an 11% increase in improvement observed between 6 and 18 months postoperatively. We propose that a longer postoperative interval (12-18 months) prior to assessment for re-treatment be advocated in order to permit optimal tissue recovery and an opportunity for collagen remodeling.     

Nonablative 1450-nm Diode Laser in the Treatment of Facial Atrophic Acne Scars in Type IV to V Asian Skin: A Prospective Clinical Study

BACKGROUND: There is presently little published data on the clinical effectiveness of nonablative lasers in the treatment of atrophic acne scars and the safety of their use in patients with darker skin types. OBJECTIVE: This study aims to determine the clinical effectiveness and safety of the nonablative 1450 nm diode laser with cryogen cooling spray in the treatment of facial atrophic acne scars in Type IV-V Asian skin. METHODS: This is a prospective non-comparative open study. 4 to 6 laser treatment sessions were performed on patients with atrophic acne scars. Final clinical assessment was performed 6 months after the last treatment. RESULTS: 57 patients were evaluated. Patient's self-assessment of scar improvement as compared with doctor's assessment was as follows: patients who completed 4 treatments (15.7% vs 6.6%), patients who completed 5 treatments (20% vs 7.9%) and patients those who completed 6 treatments (17.3% vs 5.0%). Main side effects were mild to moderate pain during the procedure, transient erythema, and hyperpigmentation which occurred in 39% of treated patients. CONCLUSION: The nonablative 1450 nm diode laser may be effective in achieving mild to moderate gradual clinical improvement in the treatment of facial atrophic acne scars. The procedure is associated with minimal downtime and is safe for use in darker skin types IV and V.     

Nonablative 1,064-nm Nd:YAG Laser for Treating Atrophic Facial Acne Scars: Histologic and Clinical Analysis

BACKGROUND Non-ablative methods have been attempted in treating atrophic facial scars, but the histologic findings do not always coincide with the clinical results and patient satisfaction.
OBJECTIVE To study the effects and safety of the Nd:YAG laser for treating atrophic facial scars.
MATERIAL AND METHODS Twelve subjects (skin phototypes II-V) with mild to moderate atrophic facial acne scars received five monthly treatments with 1,064 nm Nd:YAG laser and were photographed before, in the middle of, and 6 months after the last treatment. Histologic evaluations were performed on skin biopsies obtained before treatment and 1 month after the last session. Collagen quantification per area, before and after the treatment, was performed by morphometry, with computerized image analysis. Patient satisfaction and clinical condition were assessed using standard grading scales.
RESULTS Mild to moderate clinical improvement was observed in most patients. Photographic assessment of scars found visible cosmetic improvement in eleven patients. All patients were satisfied. There were statistically significant collagen increases in the dermis following the treatment. Side effects were limited to mild transient erythema and increased skin sensitivity after the procedure.
CONCLUSIONS The 1,064 nm Nd:YAG laser is a safe and effective nonablative method for improving atrophic scars, even in darker skin.     

Atrophic and a Mixed Pattern of Acne Scars Improved With a 1320-nm Nd:YAG Laser

BACKGROUND: Acne scar correction remains a challenge to the dermatologic surgeon. With nonablative laser resurfacing, this correction is imputed to dermal collagen remodeling and acne scar reorganization. Although atrophic acne scars tend to respond to laser treatment, the deeper ice pick and boxcar scars tend to be laser resistant. OBJECTIVE: To investigate the treatment of atrophic and a mixed pattern of facial acne scars, we evaluated a 1320-nm Nd:YAG laser. Twelve subjects with atrophic facial acne scars (N=6) or a combination of atrophic and pitted, sclerotic, or boxcar scars (N=6) received three laser treatments. Physician and patient acne scar ratings were performed at baseline and at 6 months after the last treatment. Acne scars were rated with a 10-point severity scale. RESULTS: Mean acne scar improvement was 1.5 points on physician assessments (P=0.002) and 2.2 points on patient assessments (P=0.01). Acne scars were rated more severely by patients than by the physician at all intervals. There were no noted complications at 6 months. CONCLUSION: The 1320-nm Nd:YAG laser is a safe and effective nonablative modality for the improvement of atrophic and a mixed pattern of facial acne scars.     

双波长非剥脱点阵激光“水增强法”治疗面部凹陷性瘢痕疗效观察

目的:探讨双波长(1320nm+1440nm)非剥脱性点阵激光"水增强法"治疗面部凹陷性痤疮瘢痕的临床疗效和安全性。方法:35例患者随机分成两组,治疗组(A组):先在凹陷性瘢痕处注射利多卡因注射液,然后再使用双波长非剥脱性点阵激光治疗;对照组(B组):仅使用双波长非剥脱性点阵激光治疗。每组间隔6周治疗1次,共5次。治疗前后均以ECCA权重评分表对瘢痕部位进行评分统计。结果:35例患者均完成治疗观察,经过整个疗程治疗后,所有凹陷性瘢痕均有不同程度的改善,A、B组治疗前后ECCA权重评分明显下降,经方差分析检验(P<0.05)差异有统计学意义。A、B组治愈率分别达55.4%和25.0%,无1例出现严重副反应,超过80%的患者表示满意和非常满意。结论:双波长非剥脱性点阵激光"水增强法"治疗面部凹陷性痤疮瘢痕疗效确切,安全性高,无明显副作用,为治疗面部凹陷性痤疮瘢痕开辟了一条新的思路。     

Minimally Ablative Erbium:YAG Laser Resurfacing of Facial Atrophic Acne Scars in Asian Skin: A Pilot Study

BACKGROUND Atrophic scars are dermal depressions caused by collagen damage most commonly occurring after inflammatory acne vulgaris. There are little published data regarding the effectiveness and safety of minimally invasive lasers in the treatment of atrophic acne scars in darker skin types.
OBJECTIVE The purpose was to evaluate the efficacy and safety of a low-fluence 2,940-nm erbium:YAG laser in the treatment of atrophic acne scars in Asian patients.
MATERIALS AND METHODS Nine patients aged 19 to 45 years with mild to moderate atrophic facial scars and Skin Types IV and V were treated with topical anesthesia and one to two passes with an erbium:YAG laser two times at 1-month intervals. Treatment parameters were 6-mm spot size, fluence of 400 mJ, pulse duration of 300 μs, and repetition rate of 2 Hz.
RESULTS At 2 months after the last treatment, mild to moderate clinical improvement was noted in all patients compared to baseline. Treatment was well tolerated. Side effects consisted of posttreatment erythema, peeling, and crusting, which resolved within 1 to 2 weeks. There was no postinflammatory hyper- or hypopigmentation, blistering, or hypertrophic scarring.
CONCLUSION Low-fluence erbium:YAG facial resurfacing was effective and safe in patients with mild to moderately severe atrophic acne scarring.     

高能量脉冲CO2激光修复面部凹陷性痤疮瘢痕的疗效与汽化深度

目的研究高能量脉冲CO2激光(Coherent UltraPulsed 5000 C)修复面部痤疮瘢痕疗效和汽化深度的关系.方法随访高能量脉冲CO2激光修复面部痤疮瘢痕38例,其中深陷的瘢痕18例,中等深度的瘢痕14例,浅度瘢痕6例,汽化3次以下的19例,汽化4次以上的19例.随访12～48个月.结果总有效率84.2%(32/38).汽化4次以上的,有效率100%;相反,汽化少于3次的,有效率68.4%(13/19).汽化4次以上与汽化3次下的疗效有效率差异有显著性意义(U=4.3625,P=0.0000,P＜0.0001).术后无新的瘢痕产生.结论高能量脉冲CO2激光是修复凹陷性痤疮瘢痕较好的方法,汽化深度在4次以上时,疗效较好.