皮肤色素痣不同治疗方法疗效分析比较

目的：比较冷冻、激光及手术治疗皮肤色素痣的疗效及美容效果。方法：皮肤色素痣患者4682例,分为三组：液氮冷冻组600例,用手持式冷冻刀或医用棉签行液氮冷冻治疗;激光组1882例,分别用超脉冲CO2激光和Q开关翠绿宝石激光治疗;手术组2200例,采用切除缝合或切除后邻近皮瓣修复。治疗后对疗效及副作用进行评价。结果：液氮、激光治疗较表浅的色素痣和雀斑样痣疗效较好,对皮内痣及混合痣疗效差且易产生瘢痕;手术切除缝合可治疗各种类型的色素痣,治疗次数少、术后不良反应少并且无明显切口瘢痕。结论：皮肤色素痣治疗应首选手术切除,同时术后应行组织病理学检查。对于较表浅的色素痣和雀斑样痣可选择冷冻和激光治疗,皮内痣和复合痣不宜采用冷冻和激光治疗。     

机械磨削术联合氨基酮戊酸光动力疗法治疗手部Bowen病

目的:探讨机械磨削术联合氨基酮戊酸光动力疗法(ALA-PDT)治疗手部Bowen病疗效。方法:10例经病理确诊的手部Bowen病患者,均行机械磨削术联合ALA-PDT治疗。磨削时从外向里进行磨削,磨至弥漫性出血为止。后将氨基酮戊酸配成20%溶液涂于皮损及外周0.5cm,3~4h后行635nm红光照射,能量密度为80~100J/cm2,时间20min,每周照射1次,共3次。6个月后观察肿瘤有无复发,患者满意度及瘢痕形成等情况。结果:10例患者行机械磨削联合ALA-PDT治疗后,至少随访6个月,均未见肿瘤复发;10例患者均非常满意,治疗后无明显瘢痕增生。结论:机械磨削术联合ALA-PDT治疗手部Bowen病安全高效,痛苦小,创伤轻,患者满意度高,无明显瘢痕形成,值得临床推广。     

Er:YAG Laser for the Treatment of Actinic Keratoses

BACKGROUND: There is no single optimal treatment for multiple facial actinic keratoses. The existing therapies such as topical 5-fluorouracil, chemical peels, cryotherapy, dermabrasion, and CO2 laser resurfacing can produce prolonged recovery time or are often operator dependent. OBJECTIVE: The purpose of this study was to investigate another therapeutic modality which provides a shorter recovery time with uniform results. We performed a prospective pilot study investigating the use of the Er:YAG laser for the treatment of multiple facial actinic keratoses. METHODS: Five patients with multiple facial actinic keratoses were treated with two to three passes of Er:YAG laser. Anesthesia was achieved in all cases by topical application and local infiltration when indicated. All patients were treated with 2.0 J, 5 mm spot size, and a fluence of 10 J/cm2. Clinical and histologic evaluations were performed both pre- and postoperatively. RESULTS: All patients showed a decrease in the total number of clinical actinic keratoses on the face ranging from 86 to 96%. In addition to the reversal of actinic damage in the epidermis, histologic evidence revealed increased fibroplasia and decreased superficial solar elastosis 3 months after the laser resurfacing. Reepithelialization occurred in 5-8 days, and erythema lasted for about 3-6 weeks after the procedure. There was no evidence of scarring or pigmentary changes in any of the patients during the follow-up period. CONCLUSION: Er:YAG laser skin resurfacing is a safe and effective treatment for multiple facial actinic keratoses. Histologic data suggest a new zone of collagen deposition occurs in the superficial papillary dermis. Under our current parameters, Er:YAG laser skin resurfacing has a relatively short recovery period and a low risk of scarring. Unlike the CO2 laser, Er:YAG laser skin resurfacing can be performed with topical anesthesia alone.     

磨痂保留变性真皮自体皮片移植修复手深度烧伤的研究

目的探讨磨痂保留变性真皮自体皮片移植修复手深度烧伤的可行性。方法31名烧伤患者，双手为深Ⅱ、混合度（混合深Ⅱ度、Ⅲ度）烧伤。在同体中设立磨痂组（31只手），用自制的医用烧伤磨痂器磨痂保留变性真皮，移植自体薄中厚皮片；削痂组（31只手），上止血带，用辊轴刀削痂，移植自体中厚皮片。观察两组患者术中出血量、手术时间、皮片成活率、供皮区愈合情况、组织病理学、自制医用烧伤磨痂器的使用情况、外形与功能情况。结果磨痂组术中失血量与削痂组比较无差异性（P〉0．05）；手术时间明显缩短（P〈0．01）；皮片成活率高（P〈0．05）；外形及功能满意（P〈0．05）；磨痂组供皮区愈合时间较削痂组明显缩短（P〈0．01）。组织病理学检查示，磨痂保留的创基基本无坏死组织残留，保留的真皮为玻璃透明样变性。自制的医用烧伤磨痂器结构简单、使用方便、不需电源、造价低廉、效率较高。结论磨痂保留变性真皮自体皮片移植修复手深度烧伤可作为手深度烧伤微创治疗方法的常规术式，值得推广应用。自制的医用烧伤磨痂器结构简单、使用方便、造价低廉、效率较高，可作为磨痂术的常用手术器械。     

Use of Transcyte and dermabrasion to treat burns reduces length of stay in burns of all size and etiology

BACKGROUND: With the cost of healthcare increasing, greater emphasis is placed on finding better ways to manage burn patients by increasing the quality of care while reducing length of hospital stay (LOS), thereby reducing overall cost. To date, this is the largest study to determine if Transcyte reduces LOS for partial thickness burns of any size or etiology. METHODS: All consecutive patients with deep partial thickness burns from April 2002 to December 2002 were reviewed (n=110) with IRB approval. Ninety-two patients were treated with dermabrasion and Transcyte only. Eighteen patients were treated with a combination of STSG and dermabrasion and Transcyte where appropriate. Our data was compared to the American Burn Association Patient Registry, as reported by Saffle et al. 1995. RESULTS: The data for percent TBSA and LOS are reported as mean+/-S.E.M. One-tailed t-test was used to analyze the data. Significant difference was found in patients who were treated with dermabrasion and Transcyte compared to the population reported by Saffle et al. Patients with 0-19.9% TBSA burn treated with dermabrasion and Transcyte had LOS of 6.1 days versus 9.0 days (p<0.001). Those with 20-39.9% TBSA burn had length of stay of 17.5 days versus 25.5 days. Patients treated with STSG and Transcyte who had 40-59.9% TBSA burn had length of stay of 39.7 days versus 44.6 days. Those treated with dermabrasion and Transcyte alone had length of stay of 31 days. CONCLUSION: This is the first study comparing burns of all sizes treated with dermabrasion and Transcyte with a known population receiving standard therapy. The authors found this new method of managing patients with partial thickness burns to be more efficacious and significantly reduces length of stay compared to traditional management.     

The Use of Chemical Peelings in the Treatment of Different Cutaneous Hyperpigmentations

BACKGROUND: Several chemical agents including hydroquinone, retinoic acid, and azelaic acid are currently used in the treatment of cutaneous hyperpigmentations. Recently chemical peelings with kojic acid, glycolic acid, and trichloroacetic acid, either alone or in combination, have been introduced for treatment of hyperpigmentations. OBJECTIVE: The purpose of our study was to evaluate the efficacy of trichloroacetic acid as well as glycolic acid associated with kojic acid in the treatment of cutaneous hyperpigmentations. METHODS: Twenty patients with diffuse melasma were treated with a solution composed of 50% glycolic acid and 10% kojic acid whereas 20 patients with localized hyperpigmentations (lentigo) were treated with 15%-25% trichloroacetic acid. RESULTS: Complete regression of diffuse melasma was observed in 6 of 20 patients (30%), a partial regression in 12 of 20 patients (60%), and no regression in 2 of 20 patients (10%) treated with 50% glycolic acid and 10% kojic acid. Complete regression of localized hyperpigmentations was observed in 8 of 20 patients (40%), a partial regression in 10 of 20 patients (50%), and no regression in 2 of 20 patients (10%) treated with 15-25% trichloroacetic acid. CONCLUSIONS: Based on our findings, both peelings can be considered effective in the treatment of cutaneous hyperpigmentations.     

Clinical evaluation of the efficacy and safety of combined bipolar radiofrequency and optical energies vs. optical energy alone for the treatment of aging hands

Different treatment modalities are used for the treatment and esthetic improvement of aging hands. This study evaluated the efficacy and safety of a novel technology, which combines bipolar radio frequency (RF) and optical energies for the cosmetic treatment of aging hands. The objective of the study was to assess the efficacy, safety, tolerability, and patient satisfaction of combined bipolar radiofrequency and optical energies vs. optical energy alone for the treatment of aging hands. Thirteen female patients with solar lentigines on the back of the hands were enrolled. Participants received three treatments: combined RF and intense pulsed light (IPL) on one hand and IPL treatment alone on the other. Standardized clinical photographs were taken, and patient and investigator improvement assessment (Global Esthetic Improvement (GAI) scale), patient satisfaction, and tolerability were evaluated. At the 1 and 3 months follow-up, skin laxity and pigmentation, investigator and patient improvement assessments, and satisfaction were significantly better in the hand treated with combined bipolar RF and IPL. This study demonstrates the safety and efficacy of combining RF and optical energies for the esthetic improvement of aging hands. Combined RF and IPL treatment was more efficient than IPL alone in improving skin pigmentation, skin laxity, and texture.     

Diagnosis and treatment of pigmentary disorders in Asian skin

Individuals of Asian heritage are predisposed to congenital and acquired pigmentary disorders. Cosmetic enhancement is frequently the primary treatment goal for these benign lesions. Accurate diagnosis of the nature of the pigmentary disorder is fundamental for administering safe and effective therapy. Before the advent of modern laser technology, such reported treatments as cryotherapy, dermabrasion, chemical peeling, and surgical excision resulted in unpredictable results. This article focuses on the diagnosis of disorders of pigmentation in Asian patients and reviews laser and light treatment modalities.     

Long-Term Follow-Up in Treatment of Solar Lentigo and Café-au-Lait Macules with Q-Switched Ruby Laser

A Q-switched ruby laser was used for treatment of 10 patients with solar lentigo and 12 patients with café-au-lait macules. In this study, the lesions were treated with the laser at a rate of 6 J/cm². The patients were observed for 10–21 months with an average of 13.8 months after the final session. Solar lentigos were treated once or twice, and the response rate was 70%. Café-au-lait macules were treated one to six times, and the response rate was 33%. Side effects, such as hyperpigmentation and scar formation, were rarely seen. Therefore, Q-switched ruby laser treatment is an effective treatment for epidermal pigmented lesions; however, in patients with café-au-lait macules, the responses to the treatment varied, and a repigmentation was seen in 50% of these patients. Thus, long-term follow-up is required for patients with café-au-lait macules.     

Comparison of Melanocytes Transplantation Methods for the Treatment of Vitiligo

BACKGROUND: Surgical therapy of vitiligo is indicated when depigmented macules are localized in areas that are known to respond poorly. OBJECTIVE: The objective was to compare the results of treatment of vitiliginous macules localized in the dorsum of the hands and lower limbs by transplantation of cultured autologous melanocytes plus PUVA therapy (CMP), suction blister transplantation plus PUVA therapy (SBP), cryotherapy plus PUVA therapy (CP), and only PUVA therapy (OP). METHODS: Twenty patients qualified for the study. The patients were split into two groups of 10 patients. In the first group, the CMP procedure was performed on one limb and OP on the other. In the second group, SBP and CP were used, respectively. RESULTS: The CMP procedure was successfully performed on only 6 of 10 patients, whereas SBP was carried out on all 10 patients. No significant difference was found between the number of successful transplants in both groups of patients. A total lack of effectiveness was found in CP and OP methods. CONCLUSION: This study demonstrated the advantage of the suction blister transplantation method over the autologous cultured melanocytes transplantation method because of the difficulties in cell culture establishment in some cases.     

Spread of a recurrent lentigo maligna into a graft: a case for conservative treatment.

Lentigo maligna is an in situ malignant melanoma for which the treatment of choice is surgical excision. The recurrence rate in lentigo maligna is high and hence other treatments, such as cryotherapy, laser therapy, radiotherapy and Mohs' chemosurgery, have been described. Despite the high recurrence rate, spread of a lentigo maligna into a skin graft is rare. We describe a case of a recurrent lentigo maligna spreading into a skin graft, which, along with the cases described in the literature, highlights the presence of a group of low-grade malignant lentiginous lesions that may be managed by careful follow-up and observation.     

Radiation therapy for melanomas of the head and neck

This report reviews experience with radiation therapy in 77 patients with melanoma of the head and neck, a lesion traditionally but incorrectly considered to be radiation-resistant. Thirteen patients with lentigo malignum and 18 patients with lentigo malignum melanoma have been primarily irradiated. In 11 of the 13 patients, the lentigo malignum has been locally controlled with no recurrence from 6 months to 5 years following treatment. One patient had a local recurrence and was salvaged with further radiation therapy, and one patient had residual tumor after irradiation and was salvaged with simple excision. Seventeen of 18 patients primarily irradiated had lentigo malignum melanomas that have been locally controlled from 6 months to 6 years after irradiation. One patient had a local recurrence and was salvaged by excisional surgery. There have been no deaths from lentigenous melanoma, and the cosmetic results of treatment are excellent. We concluded that radiation therapy is a simple, effective out-patient treatment for lentigo maligna and lentigo maligna melanoma. Nonlentigenous melanoma was irradiated after incisional biopsy in 6 patients; local control was obtained in 4 patients although 1 died of distant metastases. Fifteen patients were irradiated after excisional biopsy (margins inadequate); 14 of 15 had local control although 6 died of metastases. Only 2 of 16 patients irradiated for recurrent melanoma were controlled. Analysis of local control versus irradiation fraction size revealed that 17/24 (71%) achieved local control with a dose per fraction of greater than 400 rad as compared with 3 of 12 (25%) in those being irradiated with a dose of less than 400 rad per fraction. We concluded that nonlentigenous melanoma is not radiation resistant and that local excision followed by radiation therapy with a large dose per fraction deserves further study, particularly in melanomas of the head and neck where wide local excision is not possible due to age of the patient or location of the tumor. Nine mucosal melanomas have been primarily irradiated and four have been locally controlled.     

Q-switched neodymium:yttrium-aluminum-garnet laser treatment of lentigo maligna.

Lentigo maligna is a premalignant lesion of atypical melanocytes that typically arises on the head and neck of elderly patients. It is considered a melanoma in situ with a significant risk for transformation to invasive lentigo maligna melanoma. Surgery is the preferred method of treatment; however, because of the advanced age of the typical patient with lentigo maligna, the frequency of complicating medical problems, and the cosmetic or functional aspects of treatment, surgical excision is not always feasible. The purpose of this pilot study was to evaluate the efficacy and safety of Q-switched neodymium:yttrium-aluminum-garnet laser treatment of lentigo maligna. Eight patients were treated with 532 and/or 1064 nm wavelengths from the laser. All patients showed a response to laser therapy, and 2 patients treated with 1 treatment from each wavelength had complete eradication of the LM, with no evidence of recurrence in 42 months. Further study is warranted, but Q-switched neodymium:yttrium-aluminum-garnet laser is a promising alternative treatment for lentigo maligna.     

冷冻、激光及手术治疗皮肤色素痣的效果比较

目的 比较冷冻、激光及手术治疗皮肤色素痣的临床效果。方法 选择本院2021年1月-2022年 5月收治的120例皮肤色素痣患者为研究对象,按照随机数字表法分成冷冻组、激光组和手术组,每组40 例。冷冻组应用冷冻治疗,激光组应用激光治疗,手术组应用手术治疗,比较三组的临床疗效、复发情况 及并发症发生情况。结果 手术组治疗总有效率为97.50%,高于冷冻组的77.50%和激光组的80.00%,差异有 统计学意义（P＜0.05）;手术组治疗半年后复发率为5.00%,低于冷冻组的27.50%和激光组的25.00%, 差异有统计学意义（P＜0.05）;手术组治疗后不良反应总发生率为5.00%,低于冷冻组的25.00%和激光 组的22.50%,差异有统计学意义（P＜0.05）。结论 在皮肤色素痣的治疗中,手术治疗效果优于冷冻、激 光治疗,且复发率和不良反应发生率均较低,应用安全性较高,可作为皮肤色素痣的首选治疗方式,值 得临床应用。     

Follow-up survey of 308-nm laser treatment of psoriasis

BACKGROUND AND OBJECTIVES: UVB treatment with a 308-nm excimer laser is a new treatment modality for localized psoriasis. The purpose of this study is to assess patients' impressions and satisfaction with 308-nm laser treatment of mild to moderate psoriasis. STUDY DESIGN/MATERIALS AND METHODS: Telephone survey data were obtained from patients after participation in a case series study of 124 patients with mild to moderate psoriasis treated with 308-nm UVB laser treatment for a target plaque and other lesions. The survey included information on changes in the target plaque, remission time, changes in other areas of psoriasis, satisfaction with the result, side effects of treatment, and efficacy relative to other treatments. RESULTS: Patients (55% of total) reported overall satisfaction with the treatments, and 63% of patients thought they needed additional laser treatments, including for maintenance. Subjects (25%) reported that the laser treatments were better than any other treatment they had tried. Adverse effects were mild and had either disappeared or were significantly decreased in 86% of patients. Self reported length of remission compared favorably to those for other therapies for localized disease. CONCLUSIONS: UVB laser treatments provide a well-tolerated means to clear psoriasis plaques. The treatment provides a high level of patient satisfaction.     

Use of a Long-Pulse Alexandrite Laser in the Treatment of Superficial Pigmented Lesions

BACKGROUND/OBJECTIVE Although the alexandrite 755-nm-wavelength laser is effective in the treatment of unwanted hair, there are no published studies gauging the efficacy of the variable long-pulse alexandrite laser in the treatment of superficial pigmented lesions.
STUDY DESIGN/METHODS Eighteen patients underwent a single treatment session using a variable pulse-width alexandrite laser. Test sites were performed using a 10-mm spot size and up to four pulse widths (3, 20, 40, 60 ms) with and without epidermal cooling. Full treatments were performed 3 weeks later using optimum test parameters. The patients were evaluated at 3 and 6 weeks.
RESULTS Patients with darker lentigines had greater lesion clearance than those patients with lighter colored lentigines. Shorter pulse widths and treatment without cryogen cooling both, independently, lowered the fluence threshold for lentigo clearance.
CONCLUSION A long-pulse alexandrite laser is effective in clearing solar lentigines in a single pass with minimal adverse effects.     

World Survey on the Complications of Hepatic and Prostate Cryotherapy

n = 299) of whom we were aware. We requested information on the number of patients treated, the occurrence, and the clinical features of cryoshock and mortality and morbidity following cryotherapy of the prostate or liver. Altogether 134 completed questionnaires were returned (44.8%). Seventy-two centers had experience with hepatic cryotherapy and 62 with prostate cryotherapy. Following hepatic cryotherapy, the phenomenon of cryoshock was observed in 21 of 2173 patients (1%) and was responsible for 6 of 33 perioperative deaths (18.2%). Cryoshock was rare following prostate cryotherapy (2 of 5432 patients, 0.04%) and did not contribute to the overall mortality of 0.06%. Hepatic and prostate cryotherapy are safe. Cryoshock is rare after prostate cryotherapy but occurs in 1% of patients following hepatic cryotherapy. Cryoshock is associated with a high risk of death, being responsible for 18.2% of deaths in this survey. Research regarding the mechanism and possible avoidance of cryoshock is required.     

Treatment of Multiple Facial Syringomas with the Carbon Dioxide (CO2) Laser

BACKGROUND: Syringomas are benign tumors of eccrine origin most commonly found in the periorbital area. Previously reported treatments for syringomas include excision, electrodesiccation and curettage, dermabrasion, and carbon dioxide (CO2) laser resurfacing. The ideal treatment of syringomas should be destruction of the tumor with minimal scarring and no recurrence. OBJECTIVE: The objective is to present a treatment method for multiple syringomas without scarring or recurrence. METHOD: Ten patients with multiple periorbital syringomas were treated with a high energy, scanned carbon dioxide laser. Settings of 5 watts, 0.2 second scan time, and 3mm spot size were used. Two passes were performed, but some lesions required four passes. In some cases the entire lower periorbital area was treated. Results were evaluated clinically by both physicians and patients over a span of 1 to 24 months. RESULTS: Elimination of the syringomas was successful in all patients. Each patient remains free of recurrence 1 to 24 months after therapy. Prolonged erythema was the most common side effect, but no scarring was seen. Four out of the ten patients required repeat spot treatments. CONCLUSION: The CO2 laser is a dependable, safe, and nonscarring method for the treatment of periorbital syringomas.     

Reduction in recurrence risk for involved or inadequate margins with edge cryotherapy after liver resection for colorectal metastases

HYPOTHESIS: The usefulness of additional edge cryotherapy after liver resection for liver metastases from colorectal cancer to improve involved or inadequate (less than 1 cm) margins is uncertain. DESIGN: Retrospective analysis of prospectively collected data. SETTING: Department of surgery at a university hospital. PATIENTS: Eighty-six consecutive patients with hepatic metastases from colorectal cancer in whom we applied additional edge cryotherapy to involved or inadequate margins. This group was compared with 134 patients who underwent resection without edge cryotherapy (control group) during the same period. INTERVENTION: Potentially curative treatment was achieved by adding edge cryotherapy to insufficient resection sites in patients not eligible for further resection. MAIN OUTCOME MEASURES: Edge recurrence rate in the study group; validation of an additional treatment to improve curative resectability; and comparison of morbidity and local recurrence rates with the control group. RESULTS: At a median follow-up of 39 months, 47 patients were alive and 39 had died. Local recurrence at the resection site was diagnosed in 9 patients (10%), of which 7 occurred in patients with involved margins and 2 in patients with resection margin less than 1 cm. Thirty-six patients (42%) experienced recurrence in the remnant liver. Extrahepatic recurrence occurred in 38 patients (44%), the lungs being the most common site (22 patients [26%]). CONCLUSIONS: Edge cryotherapy is a potent additional surgical treatment option in patients with liver metastases from colorectal cancer. The percentage of patients who can be treated for cure can be increased, especially if complex liver surgery is demanded.     

强脉冲光及微晶磨削治疗面部寻常性痤疮的疗效分析

目的:比较强脉冲光和微晶磨削治疗不同时期面部寻常性痤疮的临床疗效。方法:将90例痤疮患者随机分为两组:A组:48例,采用强脉冲光治疗;B组:42例,采用微晶磨削治疗。治疗时间各组分别为1个疗程,治疗后观察两组的临床疗效。结果:强脉冲光治疗针对轻中度痤疮效果明显,微晶磨削治疗针对重度尤其是脓疱性痤疮及其痤疮后留下的凹陷性瘢痕效果显著,差异有显著统计学意义。结论:不同时期的痤疮采用不同方法治疗可以取得较好的临床疗效。