多波长激光治疗皮肤色素损害临床分析

目的观察比较多波长、多功能皮肤美容激光治疗不同皮肤色素性损害的临床疗效。方法应用美国产四合一多波长、多功能皮肤美容激光治疗不同皮肤色素性损害1 664例,其中雀斑103例,咖啡斑104例,太田痣78例,不理想文眉776例,文眼线251例,文唇线56例,文身189例,色斑107例。针对不同病变类型,根据不同的皮肤状况采用不同波长、能量、光斑的激光进行治疗。结果经过3～6次治疗,不同的皮肤色素损害有效率分别为:太田痣100%,咖啡斑92.30%,雀斑93.19%,色斑91.58%,文身95.23%,不理想文眉99.60%,文眼线98.79%,文唇线85.70%。结论应用多波长多功能激光治疗皮肤色素损害对太田痣、不理想文眉、文眼线效果最好,对文身、咖啡斑、雀斑效果较好。     

Q-Nd：YAG激光治疗面部色素性病变的疗效观察

面部色素性病变常见有雀斑、太田痣、咖啡斑及文刺色素沉着等.常见的治疗方法有冷冻术、皮肤磨削术、化学剥脱术及二氧化碳激光治疗术等.本院自2000年5月至2003年6月,应用Q开关钇-钕石榴石(Q-Nd:YAG)激光器,治疗面部色素性病变共291例,取得了满意的效果,现报道如下.     

Q开关钇-钕石榴石激光治疗面部色素性病变722例的护理

面部色素性病变常见有雀斑、太田痣、咖啡斑及文刺色素沉着等。我院2005-06-2008-06应用Q开关钇-钕石榴石（Q-Nd：YAG）激光器,治疗面部色素性病变共722例,取得了满意的效果。在临床护理操作中术前准备、仪器参数的选择、术中配合以及术后护理,都对治疗效果起着重要的作用。现报道如下。     

Q开关激光祛除不良文饰疗效观察

目的目的观察Q开关激光祛除不良文饰的临床疗效。方法用Q开关激光祛除文眉、文眼线、文唇等不良文饰。结果共祛除不良文饰204例,总有效率达97.55%。结论Q开关激光祛除不良文饰安全、有效。     

Nd:YAG激光去除文身着色的观察

去除文身着色，以往有化学剥脱、手术切除、电灼、磨削、激光气化等方法，但消除较大面积或图案分散、部位特殊，如文眉、文眼线等都比较困难，容易遗留瘢痕及色素沉着。我们自１９９７年６月，采用Ｑ－开关Ｎｄ：ＹＡＧ激光去除蓝黑色文身着色２００例，效果满意，报道如...     

Q开关YAG激光治疗仪治疗色素性皮肤病的疗效观察

色素性皮肤病的存在往往会给患者的心理及生活带来一定的影响,其治疗较为困难。随着现代激光技术的发展,临床上可应用激光技术治疗色素性皮肤病。本次研究应用Q开关YAG激光治疗仪治疗雀斑、咖啡斑等色素性皮肤病共685例，取得了满意的疗效，现报道如下。     

调Q开关激光治疗常见色素增加性皮肤病的临床效果分析

选取我院2014年2月~2015年2月收治的100例常见色素增加性皮肤病患者。均采用调Q开关Nd:YAG激光治疗,观察其疗效。100例患者中,治愈率67.00%,显效率93.00%,其中色素痣治愈率、显效率83.33%、95.83%,太田痣、褐青色斑55.00%、95.00%,纹身、纹眉64.52%、90.32%,雀斑、咖啡斑64.00、92.00%。针对色素增加性皮肤病患者,采用调Q开关激光治疗,有利于减轻症状,无不良反应,安全性更高,值得临床推广应用。     

Q开关倍频Nd：YAG532nm激光治疗雀斑198例临床分析

目的 观察Q开关倍频Nd:YAG532 nm激光治疗雀斑的临床疗效.方法 选用Q开关倍频Nd:YAG532nm激光治疗雀斑198例.结果 经1～2次治疗,痊愈181例(91.41%),显效16例(8.08%),无效1例,复发1例.结论 Q开关倍频Nd:YAG532nm激光治疗雀斑疗效高、操作简单、快捷安全,无不良反应.     

Q开关ND:YAG激光与液氮冷冻治疗扁平疣的疗效对比

目的比较Q开关ND:YAG激光与液氮冷冻治疗扁平疣的疗效。方法 92例扁平疣患者随机分为Q开关ND:YAG激光治疗组48例和液氮冷冻治疗组44例,观察治疗效果。结果 Q开关ND:YAG激光治疗组痊愈率93.75%,平均治疗次数1.5次;液氮冷冻治疗痊愈率75%,平均治疗次数2.8次,两组比较差异均有统计学意义(P<0.05)。结论 Q开关ND:YAG激光治疗扁平疣疗效优于液氮冷冻,值得临床推广。     

Q开关532nm激光治疗面部雀斑的疗效

目的探讨Q开关532nm激光治疗面部雀斑的临床疗效。方法对102例患者应用Q开关Nd:YAG激光治疗仪,波长为532nm,能量密度为1.8~3.0J·cm-2。结果 102例患者均经1~3次Q开关Nd:YAG 532nm激光治疗,其中治疗1次有效率为73.52%,治疗2次有效率为78.57%,治疗3次有效率为84.37%,治愈率为81.37%,总有效率为95.10%。患者治疗时局部均有轻度的灼痛感,并有轻微红肿,经冷敷20~30min后肿胀消失,24h后红斑消失,脱落结痂1周左右。5例患者治疗后出现色素沉着,1个月后无明显消退,经维生素C和维生素E片治疗4个月后消退。所有患者无感染及瘢痕发生,无色素脱失。结论 Q开关532nm激光治疗面部雀斑安全有效,不良反应少。更多还原     

可调脉宽倍频ND∶YAG激光治疗皮肤血管性疾病的疗效分析

目的　观察可调脉宽倍频ND :YAG激光治疗血管性疾病的临床疗效与治愈次数和不良反应。方法　用可调脉宽倍频ND :YAG 5 3 2nm激光治疗 115 9例皮肤血管性疾病 ,包括鲜红斑痣、草莓状血管瘤、静脉 (动脉性 )血管瘤、血管角化瘤、毛细血管扩张和蜘蛛痣。结果　治疗静脉 (动脉性 )血管瘤、草莓状血管瘤、血管角化瘤有效率均达到 85 %以上 ,蜘蛛痣为 81 2 %,毛细血管扩张为 70 9%,鲜红斑痣为 48 0 %。结论　可调脉宽倍频ND :YAG 5 3 2nm激光治疗静脉 (动脉性 )血管瘤、草莓状血管瘤、血管角化瘤及蜘蛛痣、毛细血管扩张等血管性疾病效果较好 ,治疗鲜红斑痣效果略差。治疗时能量密度过高有可能留有瘢痕     

From the Editors

Only seven years after the construction of the first laser by Maiman in 1960, the dermatologist Professor Leon Goldman/USA reported about the first therapeutic laser application in patients with vascular lesions and tattoos in his book Biomedical Aspects of the Laser. In the seventies and early eighties, mainly the argon and carbon dioxide laser were used because of their thermal destructive effects. Most important indications were port-wine stains, telyangiectasias, and the removal of tattoos.

A mile stone in laser therapy was the principle of selective photo thermolysis published by Anderson and Parish in Science in 1983. The use of a wave length with high absorption in the target structure and a very short exposure time shorter than thermal relaxation time of the target structure and a sufficiently high energy density allowed the destruction of the target within the skin without damage to the surrounding tissue. Target structures were, for example, ectatic vessels of port-wine stains, tattoo pigment, or melanin-pigmented cells.

Nowadays, lasers are an indispensable therapeutic tool in dermatology. They can be used for the treatment of vascular lesions such as port-wine stains, childhood hemangiomas and telyangiectasias, epidermal and organoid nevi, melanin pigmented lesions, tattoos, or benign tumors, inflammatory lesions, virus papillomas, sun-damaged skin, wrinkles, and for epilation.

Analogous to the many indications for laser therapy, the number of applied lasers is also very high. Lasers used for selective photo thermolysis are pigmented lesion dye lasers (PLDL,510 nm), flash-lamp pumped pulsed dye lasers (FPDL, 585 nm), long-pulsed tuneable dye lasers (LPDL, 585–600 nm), Q-switched ruby lasers (694 nm), Q-switched Nd:YAG lasers (1064 nm), frequency doubled Q-switched Nd:YAG lasers (532 nm), Alexandrite lasers (755 nm), and diode lasers (800 nm). Apart from these laser units, argon lasers (488 and 514 nm), copper vapour lasers (515 and 578 nm), Krypton lasers (589 nm), and frequency doubled Nd:YAG lasers (532 nm) are also routinely used. Cw-Nd:YAG lasers (1064 nm) are mainly applied if unspecific coagulation of the tissue is warranted. Lasers for vaporisation and ablation include cw-CO₂ lasers, pulsed CO₂ lasers, CO₂ lasers with scanner, and Erbium:YAG lasers.

Since not every indication and laser can be covered in one single issue of the journal, topics and authors were selected according to areas of interest. This issue includes articles on ablative therapy with the Erbium:YAG laser, treatment of vascular lesions, analysis of different cooling devices, a study on laser epilation, and the therapy of neurofibromatosis.

Two non-dermatological papers on “Indocyanine Green Therapy for Hypopigmented Choroidal Melanoma” and on “Optical Tomography for the Imaging of Rheumatoid Arthritis” describe techniques which are also important in dermatology.

In summary, I believe that this issue of Medical Laser Application will be of interest to readers since the articles emphasise laser therapy with regard to the scientific point of view instead of more commercially orientated cosmetic aspects. This issue will help to define the important role of lasers in dermatotherapy.     

Laser tattoo removal in Thai students

Objective

To review the results of laser tattoo removal in Thai students.

Material and methods

This is a retrospective review study of the students participating in our tattoo removal program at Srakaew Province, Thailand. The laser used was a 1064 nm Q-switched Nd:YAG laser (spot size: 3 mm, pulse duration: 6 ns, fluence: 3.5–7.5 J/cm²). A maximum of 5 laser treatments per student was performed at 2-month intervals.The data collected included age and sex of the students and information regarding the tattoos (time of tattoo existence, person who performed the tattoo procedure, method and price of tattooing, number of tattoo figures, complications during and after tattoo procedure including cleaning methods of tattoo needle) and the laser procedure (laser parameters, pain level during laser removal assessed by pain score sheet, treatment results, complications, side effects). Correlations were analyzed between the person who did the tattoo and complications after laser tattoo removal procedure, the age of tattoo and results of laser treatment and complications, and between the pain level and the time of EMLA^® application.

Results

The 115 students involved were aged between 8 years 4 months and 19 years 11 months. The mean time of tattoo existence was 1.9 ± 1.2 years. The majority of the students were tattooed (1) by amateur practitioners and (2) by hand. The costs of tattoo procedure ranged between 0 and 118 Thai Bahts. Friends influenced the students in favor of tattooing, and both the home and school were popular places for the tattooing procedure to take place. Ankles and fingers were the most common sites for students’ tattoos. A clinical clearance of 76–100% was achieved in 75% of the treated tattoos. Observed side effects were mild to moderate. Textural changes, hyperpigmentation, hypopigmentation, and scarring occurred in 41%, 3%, 3% and 17% of the cases, respectively. There was no statistically significant correlation between EMLA^® application time and the pain score. There was also no correlation between the person who did the tattoo, or the age of tattoo to the complications or side effects after laser tattoo removal.

Conclusion

The students were influenced and had tattoos by persons familiar to them, mostly at places which they often attended, including temples and schools. The students were not primarily concerned about the social consequence of having tattoos. Laser tattoo removal by means of a Q-switched Nd:YAG laser could clinically clear tattoos in 75% of the cases. However, there were side effects, such as hypopigmentation, hyperpigmentation and scarring.     

双侧太田痣的临床特点

  目的  探讨双侧太田痣的临床特点。  方法  收集1998年1月至2012年6月间在北京协和医院皮肤科就诊的双侧太田痣患者59例, 回顾性分析其发病年龄、性别、皮疹范围、是否双侧对称、皮疹颜色、巩膜是否受累、是否有合并症及特殊病例等, 其中部分病例进行组织病理检查和调Q紫翠宝石激光治疗。  结果  双侧太田痣患者占同时期太田痣患者的4.47%, 均为先天发病, 男:女=1:4.9。患者皮疹颜色为蓝褐色25例, 淡褐色34例; 皮疹双侧对称分布者47例, 双侧不对称者12例; 17例患者累及双侧3支三叉神经; 在皮疹双侧对称分布的患者中有5例患者皮疹为居中分布; 31例患者出现巩膜受累; 4例患者出现先天性血管畸形。组织病理与单侧太田痣无差异, 调Q紫翠宝石激光治疗效果好。  结论  双侧太田痣为一种先天发病的疾病, 有较高的概率出现大面积累及、巩膜受累和合并症。     

Argon Laser for Treatment of Benign Eyelid Tumors

Small lesions located in the skin might be treated using the laser system. The purpose of this is to report the therapy of benign eyelid tumors using argon laser. Forty-four benign eyelid tumors were treated using argon blue-green laser with spot size of 500 m, power from 1000 to 1200 mW and 0.3 second exposure time. The eyelid tumors were located mainly in the upper eyelid (65.9%) and the skin tag was the most frequent treated lesion (43.2%). The average number of laser shots to treat the lesions was 165. There was not observed any complication and all patients were satisfied with the results. The authors are considering the argon laser a benefit therapeutic method to treat benign tumors located in the eyelids.     

倍频激光对视网膜静脉阻塞患者视功能康复的作用

目的:评价倍频激光对视网膜静脉阻塞患者视功能康复的作用。方法:对58例(58只眼)视网膜静脉阻塞患者行倍频Nd:YAG激光治疗,随访时间3～20个月,平均9.2个月。结果:激光治疗后52例有效。光凝后视力进步36只眼;视力不变20只眼;视力下降2只眼。结论:倍频激光治疗视网膜静脉阻塞,可有效地保护患者视功能。     

The immunopathology of regression in benign lichenoid keratosis, keratoacanthoma and halo nevus

BACKGROUNDRegression is a phenomenon present in a variety of cutaneous lesions. It is likely that similar immunologic mechanisms explain the phenomenon of spontaneous regression occurring in the various lesions.METHODSTwenty-seven specimens, nine each of halo nevus, keratoacanthoma, and benign lichenoid keratosis, including three examples each of predominantly early, mid, and late regression were examined with antibodies to HLA-II, CD1a, CD3, CD4, CD8, CD20, CD34, CD56, and CD68.RESULTSEpidermotropism of inflammatory cells, including CD1a positive, CD68 positive, CD3 positive, and CD8 positive cells, was present in benign lichenoid keratosis and keratoacanthoma, but not in halo nevus. In halo nevus, the nests of halo nevus cells tended to be infiltrated by CD1a positive, CD68 positive, CD3 positive, and CD8 positive cells. The blood vessels exhibited endothelial cell swelling with luminal narrowing and disruption within the dermis of all lesions. The CD1a positive cells were increased in number in lesional epidermis except in keratoacanthoma lesions where the density of CD1a positive cells was increased in the epithelial lip, but decreased within the epithelial portion of the keratoacanthoma proper. Conversely, the CD8 positive cells were scarce in the dermis below the epithelial lip of the keratoacanthoma, but increased in the dermis of the neoplastic epithelium. CD1a positive cells were also seen throughout the dermal portion of the lesion, particularly at the lesion base. In halo nevus, the CD1a positive cells and CD68 positive cells within the lesions were larger than those in non-lesional skin, indicating activation. The composition of the inflammatory infiltrate varied within each lesion type according to stage of regression, but T-lymphocytes predominated.CONCLUSIONCytotoxic T-cells may be the final common denominator of regression in benign lichenoid keratosis, keratoacanthoma, and halo nevus. In halo nevus, cytotoxic T-cells may play the predominant role in regression. In keratoacanthoma and benign lichenoid keratosis, cytotoxic T-cells play a pivotal role, but additional mechanisms may also be involved in the phenomenon of regression. Benign lichenoid keratoses progress through stages of regression accompanied by varying proportions of inflammatory cells, including CD3, CD4, and CD8 positive T-lymphocytes, natural killer cells, macrophages and Langerhans cells.     

烧蚀时长对激光点状凝固治疗宫颈糜烂的影响

摘要：目的：确定不同烧蚀时长时的组织热扩散范围，研究烧蚀时长对ND:YAG激光点状凝固治疗宫颈糜烂的影响。方法：以离体人宫颈组织为试验对象，按完全随机的方式将组织分组，用点状光斑的ND:YAG激光对宫颈组织定点照射不同时间，关闭激光同时，利用红外热像不接触实时监测系统获取宫颈组织表面的红外辐射分布，表征其温度分布与变化情况。.结果：烧蚀时长对组织中激光热扩散特征有较大影响，当激光光斑,直径为1mm，烧蚀时长分别为2s、3s、4s和5s时，热扩散半径分别为0.8mm、1.2mm、1.5mm和2.0mm。结论：烧蚀时长对于ND:YAG激光点状凝固治疗宫颈糜烂有较大影响，需要根据烧蚀时间具体确定相邻治疗点的最佳距离。     

Histological and magnetic resonance imaging alterations after irradiation of meniscus using Holmium:YAG laser.

OBJECTIVE: The authors performed an experimental and a prospective clinical study to evaluate the histological and magnetic resonance imaging (MRI) alterations after irradiation of meniscus using holmium:YAG (Ho:YAG) laser VersaPulse Select 60 watts and InfraTome Delivery Systems 30 degrees Handpiece (spot size at fiber tip 0.4 mm; Coherent Medical, Palo Alto, CA). BACKGROUND DATA: Recently, some authors reported a few cases with articular cartilage damage or paraarticular osteonecrosis following arthroscopic knee surgery in which the laser was used to assist in the treatment of meniscal pathology. METHODS: Meniscus specimens in saline immersion were exposed to Ho:YAG laser irradiation. The laser wavelength was 2.1 microm and pulse duration was 250 microsec. Power settings were 1-1.5 joules per pulse and 10-15 Hz. Total laser energy used in these procedures was 2, 3.5, and 6 K joules. Eight patients with meniscal problems underwent arthroscopic partial meniscectomy using Ho:YAG laser. Total laser energy used for these surgeries was 1.5-2.5 K joules. MRI was performed preoperatively and at 6 months postoperatively. RESULTS: At higher energy levels (more than 3 K joules), separation of the gap between the collagen fibers, and a three-dimensional dispersion in the striation were observed on electron microscopic evaluation of meniscus specimens. No patient had abnormal signals in MRI (a sign of articular cartilage damage or osteonecrosis) following arthroscopic laser surgery. CONCLUSION: When higher energy level is required, conventional instruments should be preferred in the treatment of meniscal lesions. Laser should be reserved for the posteriorly located and smaller meniscal lesions.