激光、强脉冲光及射频技术在皮肤美容治疗中的不良反应

近几十年来,激光技术的迅猛发展使以往一些难治的皮肤病有了治疗的可能,强脉冲光、射频技术的研发更是使人们多年以来返老还童的梦想得以实现.尽管现代激光比较安全可靠,但也会对人体造成一定的伤害,即使比较安全的激光在使用不当时也会引起潜在的风险和各种不良反应,这些新技术带来优势的同时也应该注意其在操作过程中和治疗后可能出现的不良反应.概述皮肤科常见的激光、强脉冲光以及射频技术在治疗中的不良反应类型.

Abstract：

In recent decades,the rapid development of laser technology has supplied treatment choices for refractory skin diseases.Moreover,intensive pulsed light and radio frequency have made the dream to rejuvenate skin come true.Although modern laser is relatively safe and reliable,it can still cause some damage to the human body.Even safe lasers have potential risks and side effects when inappropriately applied.Careful attention should be paid to the adverse reactions during and after laser treatment.This review overviews the adverse effects of common types of laser,intense pulsed light and radio frequency technology in the treatment of skin diseases.     

强脉冲光治疗皮肤光老化的临床应用

光老化主要有皱纹、色素沉着、毛孔粗大、毛细血管扩张、皮肤平滑度降低等临床表现.经临床验证利用强脉冲光进行周期性治疗,可以有效地改善皮肤光老化症状,因为其疗效确切、副作用少,而得到广泛应用.     

强脉冲光皮肤年轻化治疗机制研究进展

强脉冲光(IPL)在皮肤科应用已十余年,疗效肯定,近年来在皮肤年轻化治疗中取得了显著效果,但其治疗机制尚未明确.本文旨在对近年有关IPL皮肤年轻化治疗的机制研究进展做一综述.     

强脉冲光在皮肤美容中的应用

强脉冲光技术已被广泛应用于皮肤美容,该技术对改善皮肤老化的系列症状效果明显。文中简要介绍强脉冲光技术的作用机制、适应证、禁忌证、治疗过程、疗效和不良反应、注意事项以及应用于皮肤美容的优缺点。     

强脉冲光治疗皮肤光老化疗效评估方法探讨

强脉冲光是一种非创伤性治疗面部光老化、光损伤的方法,可以有效的治疗面部皮肤的色素沉着、毛细血管扩张、皮肤松弛、粗糙及细小皱纹等。强脉冲光的疗效确切,但是目前缺少科学、准确的评价方法。寻找客观、准确的评价标准有利于强脉冲光更加合理的使用。     

强脉冲光治疗面部雀斑41例

我科采用强脉冲光治疗面部雀斑41例,获得满意疗效,并无明显不良反应.现总结报告如下. 1 资料和方法 1.1 临床资料 收集2005年4月-2007年4月在我科门诊就诊的雀斑患者41例,其中男5例,女36例,年龄8～39岁.皮损主要分布于双侧面颊、鼻背及额部.所有患者均无强脉冲光治疗的禁忌证,未同时接受其他系统治疗.     

强脉冲光治疗面部痤疮临床疗效分析

目的评价强脉冲光治疗面部痤疮的疗效。方法用强脉冲光治疗116例面部痤疮患者，总计治疗5次，治疗间隔3-4周。对患者治疗前后的面部情况进行照相对比评分，并观察不良反应。结果116例患者中治疗有效率为85．4％。痊愈率为41．4％。面部毛发较多的患者中有7例暂时性色素沉着持续时间较长。结论强脉冲光治疗面部痤疮有效。     

强脉冲光治疗痤疮印迹1036例回顾性分析

目的回顾分析强脉冲光治疗痤疮印迹的临床疗效。方法应用强脉冲光,波长560nm,脉冲延时25～40ms,脉宽3.0～4.0ms,脉冲模式为2脉冲和3脉冲,能量密度14～19J/cm2治疗痤疮印迹患者1036例,随访6个月,根据治疗前后患者面部照片判断疗效。结果经过1～5次治疗,面部疗效好于胸、背部,差异有统计学意义(P<0.05),胸、背部疗效差异无统计学意义(P>0.05)。红色皮损治疗效果优于褐色,但两种皮损类型总有效率比较,差异无统计学差异(P>0.05)。所有病例在治疗后均未遗留瘢痕,疗效与治疗次数正相关。结论应用560nm强脉冲光治疗痤疮印迹疗效显著,且无痛苦,不留疤痕。     

应用强脉冲光治疗面部皮肤色斑并改善皮肤整体状况

目的探讨应用强脉冲光治疗面部皮肤色斑及改善皮肤整体状况的疗效。方法对474例面部色斑患者采用强脉冲光子嫩肤仪进行治疗，共5次，每次间隔3～4周。治疗前拍照对比，医患双方分别填写疗效观察表进行评估。结果色斑治疗有效率，患者评价为89．0％，医生评价为89．7％，医患双方评价合并后为89．3％；面部皮肤状况整体改善率，患者评价为94．7％，医生评价为95．0％，医患双方评价合并后为94．8％。疗效肯定，并发症发生率低（1．5％）。结论应用强脉冲光技术治疗面部皮肤色斑及改善皮肤状况，效果满意，治疗过程无创伤，无痛苦，无结痂，无色素沉着，不需休假，是一种安全、有效和方便的治疗方法。     

强脉冲光治疗酒渣鼻疗效评价

目的:评价强脉冲光治疗酒渣鼻的疗效。方法:治疗组采用强脉冲光照射,每3周1次,4次为1疗程;对照组口服异维A酸10 mg,日2次,连续12周。结果:治疗组总有效率为89.74%,对照组为71.05%,差异有统计学意义(P0.05)。结论:强脉冲光治疗酒渣鼻疗效优于异维A酸。     

强脉冲光联合Q开关Nd：YAG激光治疗雀斑的疗效观察

目的：探讨强脉冲光联合Q开关Nd：YAG激光治疗雀斑的疗效。方法：将65例泛发性雀斑患者分为两组。对照组32例采用强脉冲光治疗,每3周一次,5次为一疗程。治疗组33例在疗程的第二次（术后3周）,采用Q开关Nd：YAG激光治疗,其余治疗方法、疗程同对照组。治疗后第6周及12周观察治疗效果。结果：治疗后6周及12周对照组和治疗组的疗效比较,差异有统计学意义（P〈0.05）。结论：强脉冲光联合Q开关Nd：YAG激光治疗泛发性雀斑创伤微小,治疗时间短,痛苦较轻,治愈率高;良好的护理对提高治愈率起着十分重要的作用。     

不同类型皮肤和不同部位运用强脉冲光子脱毛的疗效观察

目的探讨强脉冲光子脱毛的疗效与治疗次数和能量之间的关系。方法用强脉冲光子对3种类型皮肤共156例患者进行脱毛治疗。结果Ⅲ型皮肤组脱毛有效率为98.9%,IV型皮肤为95.8%,V型皮肤为86.6%。疗效与治疗次数密切相关;各部位治疗次数及能量均不同。结论强脉冲光子脱毛疗效显著,方便快捷,副反应小。     

强脉冲光与红光照射治疗痤疮后印迹的疗效比较

目的比较强脉冲光与单纯红光照射治疗痤疮后印迹的临床疗效。方法将入选的80例痤疮后印迹患者采用随机分组平行对照的实验方法分为两组,强脉冲光组(40例)每3周治疗1次,3次为1个疗程;单纯红光组2次/周,6周为1个疗程。两组均在末次治疗后1个月时判定疗效。结果强脉冲光组有效率为87.50%,单纯红光组有效率为62.50%,两组比较差异有统计学意义(P<0.01),均无严重不良反应出现。结论两者治疗痤疮后印迹均有一定的疗效,但强脉冲光组有效率显著高于单纯红光组,可达到较好的治疗和美容效果。     

Hair Removal Using a New Intense Pulsed Light Source in Chinese Patients

Background: Unwanted hair is a widespread cosmetic problem. Several lasers and intense pulsed light (IPL) have been utilized for this purpose. A new IPL device (Lumenis One^?) with OPT is one of the newer modalities to be studied in Chinese patients. Objective: This study evaluates the short-term efficacy and side effects of the new IPL device for epilation in Chinese patients. Methods: Eighteen Chinese women with Fitzpatrick skin types III–V and black hair, were treated four times at 4 to 6-week intervals using IPL (Lumenis One^?) on the axillae (n=13) and the upper lip (n=5). The energy density for treatment ranged from 14 to 22 J/cm². Parameters utilized were 695-/755-nm filters, triple pulse for patients on the axillae, and 640-/695-nm filters, double pulse for patients on the upper lip (3.5- to 7-ms pulse, 30- to 90-ms pulse delay, 15×35 mm spot size). Hair reduction was assessed at baseline, immediately before each treatment session, and at 4 weeks after the fourth treatment. Patient's satisfaction on a 5-point scale was also evaluated. Results: The average hair reduction for all sites was 49.9% after one session, 58.6% after two sessions, 79.3% after three sessions, and 83.8% after four sessions (p=0.001). The hair reduction of 44.1%, 52.1%, 81.1%, and 86.0% were achieved after each treatment for axillae, with 65.1%, 75.7%, 74.6%, and 78.0% for upper lip. Patients got more satisfaction after four sessions (score 3.1) than that after two sessions (2.0) (p=0.001). In both the assessments, upper lip appeared to show a better response than axillae after two IPL treatments, which reversed after four treatments. No significant complications or adverse events were reported. Conclusion: The new IPL device provides a safe and effective means of hair removal for Chinese patients. Treatment efficacy varies with the anatomic location and number of treatments. However, further study is necessary to determine the long-term clinical efficacy in Chinese patients.     

强脉冲光治疗雀斑的美容修复护理体会

目的探讨强脉冲光治疗雀斑术前及术后美容修复护理的重要性。方法将78例雀斑患者随机分为治疗组44例和对照组34例。治疗组在强脉冲光治疗前、后均使用美容仪器进行皮肤修复护理,并于术后选择胶原蛋白系列护肤品(商品名:露莲娜胶原蛋白系列,北京黄寺美容外科医院和北京奥通科技公司研制),对照组直接进行强脉冲光治疗。结果治疗组雀斑皮损改善有效率(90.91%)明显高于对照组(67.65%),两组差异有统计学意义(P<0.01);皮肤整体状态也较对照组明显改善。结论强脉冲光治疗雀斑结合系统的美容修复护理(面部皮肤护理配合使用胶原蛋白系列护肤品),有利于加快雀斑消退、修复皮肤组织的损伤,治疗效果和美容效果明显提高。     

Pulsed dye laser vs. intense pulsed light for port-wine stains: a randomized side-by-side trial with blinded response evaluation

Background  Pulsed dye lasers (PDLs) are considered the treatment of choice for port-wine stains (PWS). Studies have suggested broadband intense pulsed light (IPL) to be efficient as well. So far, no studies have directly compared the PDL with IPL in a randomized clinical trial.
Objectives  To compare efficacy and adverse events of PDL and IPL in an intraindividual randomized clinical trial.
Methods  Twenty patients with PWS (face, trunk, extremities; pink, red and purple colours; skin types I–III) received one side-by-side treatment with PDL (V-beam Perfecta, 595 nm, 0·45–1·5 ms; Candela Laser Corporation, Wayland, MA, U.S.A.) and IPL (StarLux, Lux G prototype handpiece, 500–670 and 870–1400 nm, 5–10 ms; Palomar Medical Technologies, Burlington, MA, U.S.A.). Settings depended on the preoperative lesional colour. Treatment outcome was evaluated by blinded, clinical evaluations and by skin reflectance measurements.
Results  Both PDL and IPL lightened PWS. Median clinical improvements were significantly better for PDL (65%) than IPL (30%) ( P  = 0·0004). A higher proportion of patients obtained good or excellent clearance rates with the PDL (75%) compared with IPL (30%) ( P  = 0·0104). Skin reflectance also documented better results after PDL (33% lightening) than IPL (12% lightening) ( P  = 0·002). Eighteen of 20 patients preferred to receive continued treatments with PDL ( P  = 0·0004). No adverse events were observed with PDL or IPL.
Conclusions  Both the specific PDL and IPL types of equipment used in this study lightened PWS and both were safe with no adverse events. However, the PDL conveyed the advantages of better efficacy and higher patient preference.     

射频联合强脉冲光在面部皮肤老化治疗中的应用

目的探讨射频联合强脉冲光技术在面部皮肤老化治疗中的作用。方法将99例面部皮肤老化者随机分为3组,射频治疗组30例,强脉冲光治疗组34例,射频联合强脉冲光治疗组35例,均治疗1个疗程后判定疗效。结果射频治疗组有效率70.00%,强脉冲光治疗组有效率70.59%,射频联合强脉冲光治疗组有效率91.43%,射频联合强脉冲光治疗组疗效均优于其他两组,差异均有统计学意义(P均<0.05)。结论射频联合强脉冲光法在面部皮肤老化治疗中的疗效显著,且安全可靠。     

The Efficacy of Intense Pulsed Light for Treating Erythematotelangiectatic Rosacea Is Related to Severity and Age

Background

Rosacea is a chronic cutaneous disease. Therapeutic modalities should be chosen based on the identified sub-types and clinical features in each patient. Vascular lasers, including intense pulsed light (IPL), are reportedly safe and effective in treating erythematotelangiectatic rosacea (ETR).

Objective

In this study, we assess the comparative efficacy of IPL related to several factors including clinical severity and the age of patients with ETR.

Methods

Patients with ETR were classified into two groups according to the National Rosacea Society Severity Guideline. Severity score and erythema index (EI) were measured using a clinical scorecard and mexameter. For additional evaluation of therapeutic efficacy, investigator and patient global assessments (IGA, PGA) were checked. Efficacy of IPL was analyzed according to severity score, EI, IGA, and PGA related to sex, age, lactic acid stinging test, and severity.

Results

Analyses of the efficacy of IPL according to severity score, EI, IGA, and PGA based on sex, age, lactic acid stinging test, and severity revealed significant differences with age and severity only.

Conclusion

This study supports the efficacy of IPL treatment for patients with ETR. IPL may be more effective in patients with more severe ETR and in younger patients with ETR.     

Clinical Efficacy and Side Effects of Acitretin on the Disorders of Keratinization: A One-year Study

Acitretin, Ro 10-1670, the principal and free acid metabolite of etretinate, was used to treat twenty patients with disorders of keratinization. An open, prospective study of clinical efficacy, tolerability, and the effects of acitretin on lipid metabolism, hepatic function, and the osteoarticular system was performed over a one year period. Each patient was initially treated with 30 mg/day of acitretin or approximately 0.6 mg/kg/day. Doses were adjusted according to the clinical efficacy and maintained for one year. There were no statistically significant changes in liver function tests or lipid profile. Twelve of eighteen evaluated patients developed asymptomatic skeletal changes; the most common change was disc space narrowing, especially at thoracic-spine level (7 of 18 patients). The earliest bone change was detected 9 months after treatment. Acitretin is effective in improving the disorders of keratinization with mild mucocutaneous side effects and asymptomatic osteoarticular changes.     

Intense pulsed light in the treatment of non‐aesthetic facial and neck vascular lesions: report of 85 cases

Background Intense pulsed light (IPL) treatment is one of the most effective procedures for patients with non‐aesthetic vascular lesions in addition to signs of skin photoageing, and it has been reported as very successful in the treatment of telangiectasias, spider nevi, erythrosis, and above all, rosacea and poikiloderma. Its use is based on the principle of selective photothermolysis, which exploits the haemoglobin absorption peak among its range of wavelengths. Objective The aim of this study is to assess the efficacy and safety of intense pulsed light in treating non‐aesthetic vascular skin lesions, especially with regard to poikiloderma of Civatte and rosacea. Methods A total of eighty‐five patients, 64 women and 21 men, with 63 non‐aesthetic vascular lesions (28 Poikiloderma of Civatte and 35 rosacea), 22 pigmented lesions (UV‐related hyperpigmentation of solar lentigo‐type) and four precancerous lesions (actinic keratosis, AKs), were treated repeatedly with IPL for 2 years. The patients received a mean of five treatments (range 4–6) at 3‐weekly intervals. They were evaluated via clinical observations and professional photographs were taken before each treatment and after 2 weeks, 4 weeks, 3 months, 6 months and 12 months. The outcome of the IPL treatments was evaluated by four independent dermatologists, who were not informed about the study protocol, and who assessed the performance of IPL by dividing the results into four categories: no results, slight improvement, moderate improvement and marked improvement. Results All the patients showed improvements in their overall lesions: 72 lesions (80.9%) achieved a marked improvement, 14 lesions (15.7%) achieved a moderate improvement and three lesions (3.4%) achieved a slight improvement. The results of the 63 non‐aesthetic vascular lesions in Rosacea and Poikiloderma of Civatte were: 51 with a marked improvement, 10 with moderate improvement, whereas only two lesions achieved a slight improvement. The improvement of all four actinic keratoses was marked whereas the 22 pigmented lesions obtained a marked improvement in 17 cases, a moderate improvement in four cases and a slight improvement in one case. No undesirable effects were observed. Conclusions Our study confirms how by minimizing side‐effects, time and costs, IPL can be effective and safe for the treatment of non‐aesthetic facial and neck vascular lesions.