点阵激光治疗痤疮性瘢痕进展

痤疮后凹陷性瘢痕是痤疮愈合后常见的后遗症,给患者的生活和心理带来很多困扰。传统的治疗方法很多,如化学剥脱、外科切除、磨削、组织填充等,但这些方法疗效不甚理想,常常伴有术后感染、瘢痕加重及色素变化等严重的不良反应。点阵激光是以局灶性光热作用原理作为理论指导的一种新型激光治疗模式,可分为剥脱性点阵激光和非剥脱性点阵激光,在痤疮瘢痕的治疗中取得了显著的疗效。     

点阵激光的临床应用进展

由于点阵激光具有疗效肯定,安全性高和停工期短等优点,已成功用于治疗痤疮瘢痕和光老化等.与传统的剥脱性和非剥脱性激光不同,点阵激光仅作用部分皮肤,保留周围正常皮肤,从而有利于快速愈合和减少停工期.点阵激光通过微治疗孔传递高能量到达真皮层,从而保证疗效,而避免传统剥脱性激光容易出现的风险为持续性色素减退和瘢痕.概述近几年剥脱性和非剥脱性点阵激光在瘢痕、光老化、萎缩纹、色素性疾病、脱发和点阵激光经皮给药等的临床应用、机制和疗效.     

点阵激光在皮肤科的临床应用及进展

点阵激光第一次报道于2004年,是为得到明显美容效果和最低风险美容技术而引进市场的。与传统的剥脱和非剥脱激光不同的是,剥脱点阵激光和非剥脱点阵激光治疗的仅仅是皮肤的一小部分,最多可有约95%的皮肤不受累,未受损害的周围组织包绕受损组织可使表皮迅速修复。2006年FDA批准非剥脱性点阵激光可用于治疗色素损害、眶周皱纹、皮肤重塑、黄褐斑、软组织凝结、痤疮瘢痕、外科瘢痕和光化性角化症。2007年这个概念被进一步发展到剥脱性点阵激光(Er:YAG或CO2激光),这些设备由FDA明确指出用于治疗各种皱纹、组织结构不平整、色素损伤和血管皮肤变色。本文就剥脱和非剥脱点阵激光这两个概念及其技术细节和临床指征进行了综述。     

强脉冲光及非剥脱点阵激光治疗痤疮瘢痕研究进展

随着强脉冲光与非剥脱点阵激光的问世,痤疮凹陷性瘢痕的治疗相对变得容易许多。而且治疗效果好,不良反应小。强脉冲光在皮肤美容界应用广泛,在治疗早期痤疮痘痕及浅表凹陷性瘢痕方面有较为明显的疗效。另外,在维持皮肤年轻化方面更容易被广大求美者接受。非剥脱点阵激光在治疗痤疮凹陷性瘢痕上疗效更加显著,它以独特的点阵微孔、选择性光热作用占据领先地位。强脉冲光和非剥脱点阵激光联合治疗,会更好的发挥激光设备的优势,起到更好的治疗作用。     

点阵激光不良反应及防治对策

点阵激光利用局灶性光热分解作用部分皮肤组织,保留周围正常皮肤,应在保证疗效的同时尽量避免造成皮肤不可逆的损伤.由于激光参数、操作者的经验和患者个体差异较大,点阵激光治疗仍会出现一些不良反应,从而影响疗效.近几年国内外剥脱性或非剥脱性点阵激光治疗出现不良反应,例如,红斑、炎症后色素沉着、感染、瘢痕和痤疮样疹等,因此,应重视不良反应的发生率及导致其发生的危险因素,并研究防治对策,供临床参考.     

CO2点阵激光及其联合疗法治疗凹陷型痤疮瘢痕进展

痤疮瘢痕是常见的痤疮后遗症之一,严重影响患者的身心健康,常见的治疗方法有:药物治疗、激光治疗、射频治疗、填充治疗、化学剥脱、微针疗法、富血小板血浆治疗、外科治疗等.目前剥脱性CO2激光仍然是主流的治疗方式,本文综述CO2点阵激光及其联合疗法治疗凹陷型痤疮瘢痕的疗效及其安全性,为临床提供参考.     

1550nm非剥脱点阵激光治疗痤疮瘢痕的疗效观察

目的:观察1550 nm非剥脱点阵激光治疗痤疮瘢痕的疗效。方法:选取痤疮瘢痕患者37例,应用1550 nm非剥脱点阵激光治疗,采用GoodmanBaron痤疮瘢痕分级系统和GoodmanBaron痤疮瘢痕评分系统对疗效进行评估。结果:治疗后,43%(16/37)的患者GoodmanBaron痤疮瘢痕分级有改善,2%(1/37)的患者分级改善2级,41%(15/37)的患者分级改善1级。治疗后,92%(34/37)的患者GoodmanBaron痤疮瘢痕评分有改善,改善分数最高为13分,最低为0分,平均改善分数为3.24分。治疗中均未发现任何严重不良反应。结论:1550 nm非剥脱点阵激光是治疗痤疮瘢痕安全、有效的方法。     

1565nm非剥脱点阵激光联合超分子水杨酸治疗面部轻中度痤疮的疗效观察

目的探究1 565nm非剥脱点阵激光联合超分子水杨酸治疗面部轻中度痤疮的临床疗效。方法收集2018年3月—2019年6月就诊的99例面部轻中度痤疮患者,随机分为超分子水杨酸组(33例)、1 565nm非剥脱点阵激光组(33例)和联合治疗组(33例)。其中超分子水杨酸组予以超分子水杨酸治疗,1 565nm非剥脱点阵激光组进行1 565nm非剥脱点阵激光治疗,联合治疗组予以1 565nm非剥脱点阵激光及超分子水杨酸治疗。治疗12周后,观察三组患者临床疗效及不良反应情况。结果治疗12周后,超分子水杨酸组与1 565nm非剥脱点阵激光组临床治疗总有效率比较差异无统计学意义(P 0.05);联合治疗组临床治疗总有效率显著高于单一治疗组(P 0.05)。三组患者均无严重不良反应。结论 1 565nm非剥脱点阵激光联合超分子水杨酸治疗面部痤疮临床疗效显著,且安全性高。     

点阵CO_2激光联合皮下分离术治疗痤疮凹陷性瘢痕的疗效观察

目的分析点阵CO_2激光联合皮下分离技术治疗痤疮凹陷性瘢痕的应用价值。方法选取2018年6月到2020年10月某医院收治的痤疮凹陷性瘢痕患者82例,随机分为研究组(n=41)和对照组(n=41),对照组予以点阵CO_2激光治疗,研究组予以点阵CO_2激光联合皮下分离治疗。对比两组术前、术后6个月临床痤疮瘢痕评估量表(ECCA)权重评分、瘢痕面积、色素沉着面积变化和凹陷边缘直径减少50%所用时间变化。结果术后6个月,研究组ECCA权重评分明显低于对照组;术后6个月,研究组瘢痕面积、色素沉着面积明显小于对照组;研究组凹陷边缘直径减少50%所用时间明显短于对照短,且上述差异均有统计学意义(P 0.05)。结论点阵CO_2激光联合皮下分离技术治疗痤疮凹陷性瘢痕可促进瘢痕恢复,减少瘢痕面积和色素沉着面积。     

激光辅助透皮给药技术应用于皮肤科的进展

激光具备精准、可控性高和技术成熟的优点广泛应用于临床,在辅助透皮给药技术时激光能通过改变皮肤屏障来提高药物的渗透量和作用深度,其中剥脱性点阵激光因创伤小、不良反应少,能有效增加渗透率而作为首选.影响疗效的主要因素可分为点阵激光的覆盖率、能量及药物的封包时间和相对分子质量.在皮肤科临床,剥脱性点阵激光辅助透皮给药技术能有效提高皮肤基底细胞癌、光线性角化病和增生性瘢痕的疗效,降低甲氨蝶呤治疗银屑病的药物浓度,不论是动物实验还是临床试验均证明其应用于一些皮肤病治疗的可行性.     

超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕40例分析

目的：评价超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的疗效.方法：面部萎缩性痤疮瘢痕40例,根据患者皮肤类型、痤疮瘢痕形状、深度、密度选用超脉冲CO2点阵激光的参数治疗,并进行治疗前后对比.结果：与治疗前相比,总有效率为92.5%,治疗中未观察到严重不良反应.结论：超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕疗效显著,副作用小,安全性高.     

黄金微针射频与超脉冲CO2点阵激光治疗面部痤疮所致的不同类型凹陷性瘢痕的疗效比较

 目的 比较黄金微针射频与超脉冲CO₂点阵激光治疗不同类型面部凹陷性痤疮瘢痕的临床疗效及安全性。方法 选取我院门诊2019年8月—2021年8月诊治的80例凹陷性痤疮瘢痕患者为研究对象,采用随机数字表法分为治疗组和对照组,每组各40例。治疗组采用黄金微针射频治疗;对照组采用超脉冲CO₂ 点阵激光治疗。比较两组疗效,并按临床亚型（V型、U型和M型）对患者进行分类和评价。结果 两组患者治疗后痤疮瘢痕临床评分量表（ECCA）权重评分均降低,但差异无统计学意义（t=0.46, P=0.644）。 两组患者总体有效率比较差异无统计学意义（X²=1.89,P=0.176）。两组瘢痕亚型比较,治疗组M型瘢痕疗效较好（t=2.34, P＜0.05）,对照组V型瘢痕疗效较好（t=-2.36, P＜0.05）,而两组U型瘢痕疗效无明显差异（t=0.24, P＞0.05）。治疗组患者术中疼痛程度、术后红肿期程度评分均低于对照组,痂皮脱落愈合时间短于对照组,差异均有统计学意义(均P＜0.05)。结论 黄金微针射频与CO₂点阵激光均能有效地改善面部凹陷性痤疮瘢痕,其中前者对M型瘢痕疗效显著,后者对V型瘢痕疗效显著。提示临床工作中可对痤疮瘢痕进行亚型分析,进而选择性治疗,必要时可联合治疗,起到协同作用。     

The efficacy of fractional ablative carbon dioxide laser combined with other therapies in acne scars

Fractional ablative carbon dioxide laser resurfacing is a frontline treatment for acne scars. It creates multiple microscopic treatment zones to accelerate the collagen formation and the healing process of reepithelialization, according the principle of fractional photothermolysis. At present, the fractional CO₂ laser with a wavelength of 10,600 nm is commonly used in the field of cosmetology and clinical therapies for various skin diseases, and it can effectively improve skin regeneration and scar formation. To obtain satisfactory results for patients with scars, repetitive fractional laser therapy is always required; however, this treatment could easily lead to complications such as erythema, edema, infection, and post‐inflammatory hyperpigmentation. In addition, different types of acne scars may have different responses to laser, further limiting its widespread use. In recent studies both home and abroad, a new pattern of fractional laser combined with other therapies to improve acne scar has been recommended to guarantee the safety and effective of treatment. This article reviews the recent pertinent literatures and summarized the progression of ablative fractional CO₂ laser combined with other therapies on acne scar.     

The efficacy of fractional CO2 laser in acne scar treatment: A meta‐analysis

Fractional CO₂ laser is a good option for treating acne scars. However, the clinical efficacy of this treatment modality requires further evidence. To perform a meta‐analysis to assess clinical improvements in acne scars with fractional CO₂ laser and non‐CO₂ laser therapies. Databases (PubMed, Embase, Cochrane Library) were searched using the search strategy to identify eligible studies. All statistical analyses were performed using the Review Manager 5.0, and a meta‐analysis was conducted to assess the effects of fractional CO₂ laser used as a treatment for acne scars. Eight studies were included for further analysis. There was no significant difference between fractional CO₂ laser and non‐CO₂ laser therapies in terms of clinical improvement, observer assessment (P = .19), patient assessment (P = .91), and incidence of post‐inflammatory hyperpigmentation (P = .69). The subgroup analyses showed that the duration of follow‐up had little effect on the evaluation of treatment effect. The efficacy of fractional CO₂ laser therapy in acne scars appeared to be equal to that of non‐CO₂ laser therapies. More well designed randomized controlled trials and more credible and standard evaluation criteria are needed, and the efficiency of combination therapy requires further analysis.     

Fractional CO2 laser for the treatment of acne scars

Background Numerous reports have been published on skin rejuvenation by the so‐called fractional laser device that delivers a laser beam in a dot form over a grid pattern. Aims In this study, we characterized the effects of a fractional CO₂ laser on atrophic acne scars at the clinical and ultrastructural levels. Methods Seven healthy adult Japanese volunteers (aged 32–46 years, mean 37.6, five men and two women of Fitzpatrick skin type III) were recruited for this study. A fractional CO₂ laser device, SmartXide DOT (DEKA, Florence, Italy), was used with irradiation parameters set as follows: output power 10 W, pulse width 600 μs, dot spacing 800 μm, and stack 2 (irradiation output power 0.91 J/cm²). A clinical examination and punch biopsy of each subject was performed before and just after the irradiation, and also at week 3 after three irradiation sessions. The biopsy specimens were stained with toluidine blue and were examined ultrastructurally. Results Clinical improvement of the atrophic acne scars was observed at week 3 after the third irradiation session in all cases compared with the condition before treatment. Histologically, outgrowths of many degenerated elastic fibers were observed as irregular rod‐shaped masses in the superficial dermis prior to the treatment in the region of the acne scars. At week 3 after the third irradiation, the degenerated elastic fibers were no longer observed, and the elastic fibers were elaunin‐like. Conclusions The fractional CO₂ laser is considered to be very effective for treating atrophic acne scars.     

Clinical trial of a pinpoint irradiation technique with the CO2 laser for the treatment of atrophic acne scars

Ablative laser resurfacing is an effective treatment for atrophic acne scars. However, it often induces complications such as edema, prolonged erythema, scarring and hyperpigmentation. Therefore, a new concept of laser treatment called fractional photothermolysis has been designed to create microscopic thermal wounds to achieve skin rejuvenation treatment of atrophic acne scars. This study was designed to prospectively evaluate the use of a technique similar to fractional photothermolysis using only the standard CO₂ laser without the fractional laser device in the treatment of atrophic scars and demonstrates it as a safe, effective and economical treatment option. Clinical improvement was achieved in all 35 patients with minimal adverse effects.     

Efficacy of Punch Elevation Combined with Fractional Carbon Dioxide Laser Resurfacing in Facial Atrophic Acne Scarring: A Randomized Split-face Clinical Study

Background:

A number of treatments for reducing the appearance of acne scars are available, but general guidelines for optimizing acne scar treatment do not exist. The aim of this study was to compare the clinical effectiveness and side effects of fractional carbon dioxide (CO₂) laser resurfacing combined with punch elevation with fractional CO₂ laser resurfacing alone in the treatment of atrophic acne scars.

Materials and Methods:

Forty-two Iranian subjects (age range 18–55) with Fitzpatrick skin types III to IV and moderate to severe atrophic acne scars on both cheeks received randomized split-face treatments: One side received fractional CO₂ laser treatment and the other received one session of punch elevation combined with two sessions of laser fractional CO₂ laser treatment, separated by an interval of 1 month. Two dermatologists independently evaluated improvement in acne scars 4 and 16 weeks after the last treatment. Side effects were also recorded after each treatment.

Results:

The mean ± SD age of patients was 23.4 ± 2.6 years. Clinical improvement of facial acne scarring was assessed by two dermatologists blinded to treatment conditions. No significant difference in evaluation was observed 1 month after treatment (P = 0.56). Their evaluation found that fractional CO₂ laser treatment combined with punch elevation had greater efficacy than that with fractional CO₂ laser treatment alone, assessed 4 months after treatment (P = 0.02). Among all side effects, coagulated crust formation and pruritus at day 3 after fractional CO₂ laser treatment was significant on both treatment sides (P < 0.05).

Conclusion:

Concurrent use of fractional laser skin resurfacing with punch elevation offers a safe and effective approach for the treatment of acne scarring.     

Clinical trial of a laser device called fractional photothermolysis system for acne scars

Ablative laser resurfacing is an effective treatment for acne scars. However, edema and prolonged erythema are common. Additionally, scarring and hyperpigmentation are often induced. A new concept of laser called fractional photothermolysis has been designed to create microscopic thermal wounds to achieve skin rejuvenation without significant side-effects. We treated 10 patients with acne scars using this laser system (Reliant Fraxel SR Laser). All the patients were successfully treated with minimal adverse effects. The fractional photothermolysis system represents an optional method for the treatment of acne scars.     

皮秒翠绿宝石激光与超脉冲CO2点阵激光治疗面部萎缩性痤疮瘢痕的疗效与安全性比较

【摘要】 目的 通过前瞻性、半脸对照研究，比较皮秒翠绿宝石激光与超脉冲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 2015年10月至2017年10月在中国医学科学院皮肤病医院激光科收集面部对称性萎缩性痤疮瘢痕患者，左侧面部痤疮瘢痕采用超脉冲CO2点阵激光治疗，右侧采用皮秒翠绿宝石激光点阵模式治疗，治疗间隔为2个月，共治疗3次。治疗前后由皮肤科医生根据ECCA评价表对瘢痕进行评分，患者根据四分法自评临床疗效。记录治疗时疼痛程度和不良反应。两侧间、治疗前后ECCA评分及疼痛程度评分比较采用配对t检验，组间四分法评分比较采用 Wilcoxon 秩和检验。结果 治疗前皮秒激光侧和点阵激光侧间ECCA评分差异无统计学意义（t = 1.06，P = 0.300），治疗3次后差异有统计学意义［（70.98 ± 21.48）分比（58.04 ± 17.63）分，t = 3.76，P = 0.001］。与治疗前相比，皮秒激光侧瘢痕改善评分（2.21 ± 1.09）分，CO2点阵激光侧（2.83 ± 1.11）分，两组差异有统计学意义（z = 2.70，P = 0.007）。与CO2点阵激光侧相比，皮秒激光侧不良反应更少，表现为一过性红斑、水肿，治疗疼痛评分亦明显降低［（3.71 ± 0.62）分比（6.23 ± 1.06）分，t = 11.93，P < 0.001］。结论 皮秒翠绿宝石激光与超脉冲CO2点阵激光均能有效改善萎缩性痤疮瘢痕，CO2点阵激光疗效更显著，而皮秒激光不良反应更少。     

Cosmetic therapies for Chinese patients with acne taking concomitant or recent intake of oral isotretinoin: A retrospective study

Background

The current standard recommendation is to initiate the cosmetic therapies after discontinuing taking oral isotretinoin for at least 6 months. However, this recommendation has been questioned in several recent publications, and it is difficult to operate in clinical practice as early initiation of effective treatment is desirable for patients with acne sequelae.

Objective

The purpose of this study is to evaluate the efficacy and safety of chemical peeling and light/laser or radiofrequency treatments combined with oral isotretinoin for patients with acne vulgaris and acne scars.

Method

A retrospective study of 511 patients on/or recently administered with isotretinoin treated with glycolic acid, intense pulsed light, nonablative fractional laser, fractional radiofrequency, and ablative carbon dioxide laser. A total of 1352 interventions were performed. The medical follow-up lasted for at least 1 year. The efficacy and safety of different procedures were evaluated.

Results

A total of 511 patients, who were treated with isotretinoin orally or stopped for <6 months, received 477 sessions of glycolic acid chemical peeling treatment, 588 sessions of intense pulsed light treatment, 61 sessions of nonablative fractional laser treatment, 101 sessions of fractional radiofrequency treatment, and 125 sessions of ablative fractional carbon dioxide laser treatment. No hypertrophic scars and keloids were found, and the incidence of serious adverse reactions such as scarring, erythema, blisters, and postinflammatory hyperpigmentation did not increase.

Conclusions

It is safe to perform skin procedures in patients with acne and acne scars during or after discontinuation of isotretinoin for <6 months. Invasive treatments such as ablative fractional carbon dioxide laser treatment can be performed, as appropriate, by an experienced physician. The guideline of avoiding chemical and physical procedures in such patients taking oral isotretinoin should to revised.