中波紫外线治疗色素减退性皮肤病

目的：探讨在黄种人中应用中波紫外线(UVB)治疗色素减退性皮肤病的方法、效果及影响因素。方法：应用中波紫外线治疗白癜风、妊娠纹、色素减退性瘢痕等色素减退性皮肤病共40例。结果：中波紫外线治疗色素减退性皮肤病的有效率分别为：白癜风60％；妊娠纹80％；色素减退性瘢痕60％；三种疾病的治疗效果无统计学差异。治疗效果与皮损面积有关，面积较小者治疗效果较好，不良反应较轻。结论：中波紫外线是一种安全有效的治疗常见色素减退性皮肤病的方法。     

第一讲色素性皮肤病的概述与分类

色素增加性皮肤病是一类常见的有碍美容的色素障碍性疾病，可由遗传、环境等因素引起，常影响患者的自信心、外在形象及社交等，多数求治心切。因其存在普遍性，应广大读者要求，我刊特邀广州军区总医院皮肤科杨慧兰主任等专家撰文进行专题讲座，就色素增加性皮肤病的病因、发病机理和临床经验及目前的治疗进展等进行深入讨论，欢迎广大读者来信来函交流。相关章节具体如下： 第一讲：色素性皮肤病的概述与分类；第二讲：黄褐斑的治疗；第三讲：雀斑的治疗；第四讲：色素细胞性肿瘤；第五讲：色素性皮肤病的鉴别诊断；第六讲：色素性皮肤病的治疗及进展；第七讲：激光在色素性皮肤病中的应用；第八讲：常见色素增加性皮肤病的中医诊治；第九讲：色素增加性皮肤病激光治疗后的护理。[编者按]     

Q开关Nd：YAG激光治疗色素性皮肤病5000例疗效观察

目的：观察Q开关Nd：YAG激光治疗色素性皮肤病的疗效、影响因素及副反应。方法：使用Q开关Nd：YAG激光治疗色素性皮肤病患者5000例,浅表性色素损害雀斑、咖啡斑和老年斑采用Q532nm波长,太田痣和文身采用Q1064nm波长。结果：本组患者经1～6次治疗,总有效率达96．14％,术后出现暂时性色素沉着269例（5．38％）,无瘢痕发生。结论：Q开关Nd：YAG激光治疗色素性皮肤病疗效较好,安全性高。     

美容消斑汤联合水光注射氨甲环酸治疗肝气郁结型黄褐斑的疗效及对皮肤屏障功能修复的影响

目的：观察美容消斑汤联合水光针治疗肝气郁结型黄褐斑的疗效及对皮肤屏障功能修复的影响。方法：分析笔者医院应用美容消斑汤联合水光针治疗的55例黄褐斑患者的病例资料，利用黄斑面积和严重指数(Melasma area and severity index,MASI）进行定量评价，评估患者疗效及皮损状况，使用多功能皮肤测试仪检测患者皮肤屏障功能，并采用皮肤病生活质量指数（Dermatology life quality index,DLQI）量表评价患者生活质量。结果：治疗后，患者治疗总有效率达90.91%；患者皮损情况（皮损面积、皮损颜色）评分和皮损区经表皮水分流失值、黑色素含量显著低于治疗前，角质层含水量显著高于治疗前,差异均有统计学意义（P<0.05）；与治疗前比较，患者治疗后DLQI量表心理状态、生理状态、日常活动、社交娱乐评分均显著降低,差异均有统计学意义（P<0.05）；治疗期间未出现严重不良反应。结论：美容消斑汤联合水光针治疗肝气郁结型黄褐斑具有显著疗效，能够改善患者皮损情况，促进皮肤屏障功能的恢复，并提高患者生活质量水平。     

表皮移植术治疗白癜风疗效观察

白癜风是一种常见的色素性皮肤病,表现为局部或泛发性色素脱失,明显影响患者外观美容及社会交往。目前治疗方法很多,疗效不一。笔者应用表皮移植术治疗白癜风患者,取得了良好效果,现报道如下。     

Q-Nd:YAG激光治疗色素性皮肤病变疗效观察

目的：Q－Nd:YAG激光治疗色素性皮肤病变的效果。方法：应用Q－Nd:YAG激光1064nm,532nm波长对544例色素性皮肤病变进行治疗。结果：总有效率为96％，对色素痣的疗效欠佳。结论：采用Q－Nd:YAG激光治疗色素性皮肤病变具有效果显著，副作用少的特点，为目前理想的治疗方法。     

高能脉冲激光治疗色素性和血管性皮肤病临床观察

目的:探讨多波长高能脉冲激光治疗色素性及血管性皮肤病的临床疗效及其影响因素。方法:使用多波长高能脉冲激光治疗色素性及血管性患者1 072例。浅表性色素损害如雀斑、咖啡斑和老年斑采用Q532 nm和Q755 nm治疗;太田痣和文身采用Q1 064 nm和Q755 nm;血管性疾病如血管瘤、鲜红斑痣和蜘蛛痣采用VPW532nm激光治疗。结果:本组患者痊愈率38.34%(411/1 072),有效率87.41%(937/1 072),经过1～8次治疗,雀斑、太田痣、文刺、老年斑、毛细血管扩张及蜘蛛痣的总有效率高达90%以上。血管瘤、太田痣和咖啡斑有效率分别为84.38%、71.05% 及45.00%。多因素分析结果显示:治疗效果与治疗次数、病程、激光强度和光斑大小有关(OR>1,P<0.05),术后出现暂时性色素沉着和色素减退23例(2.14%),无瘢痕发生。结论:多波长高能脉冲激光治疗色素性及血管性皮肤病疗效较好,安全性高。     

Q-开关翠绿宝石激光治疗常见色素增加性皮肤病临床疗效观察

目的：探讨Q-开关翠绿宝石激光治疗常见色素增加性皮肤病的疗效及安全性。方法：应用AlexLazr Q-开关翠绿宝石激光不同剂量针对360例面部色素增加性皮肤病患者进行治疗,并随访3～6个月,观察治疗后效果及预后。结果：总有效率为98.6%,术后出现局部紫癜、疼痛、暂时性色素沉着、水疱等,无色素减退和瘢痕出现。结论：Q-开关翠绿宝石激光治疗常见色素增加性皮肤病安全、有效。     

XH超高频皮肤整形仪治疗面部色素性皮肤病变

目的：观察XH超高频皮肤整形仪对面部色素性皮肤病变的治疗效果。方法：选择合适的电极对7种269例面部色素性皮肤病变进行治疗。结果：特定频段的超高频电极可使皮肤病变组织气化，治疗有效率89.6％，但对太田痣、不良文饰、色素痣等部分皮肤损害达真皮深层或全层的病例效果欠佳。结论：超高频皮肤整形仪对面部色素性皮肤病变的治疗效果良好。     

强脉冲光治疗皮肤色素性疾病的临床观察

目的　光子嫩肤技术是用强脉冲光改善皮肤光老化的非剥脱治疗 ;对皮肤色素病有较好疗效。观察强脉冲光对颜面常见色素性皮肤病的短期疗效。方法　应用强脉冲光对患者面部照射 ,治疗波长为 5 6 0nm ,治疗脉宽为2 .4～ 6ms,每个光斑 2～ 3脉冲 ,能量密度 2 4～ 36J/cm2 。每隔 3周治疗一次 ,5～ 6次为一个疗程。每次治疗前采集皮损图像。按痊愈、显效、有效及无效 4级做出评价。结果　受治患者综合疗效有不同程度改善。色素性疾病中 ,雀斑和脂溢角化病的疗效最明显 ,毛细血管扩张也有显著疗效。其他色素病有不同程度消退。经半年以上随访未见复发。结论　强脉冲光可治疗毛细血管扩张以及多种色素性皮肤损害 ,改善皮肤外观。其优势为无创伤 ,痛苦小 ,不影响工作     

Hypoepiluminescence Microscopy of Pigmented Skin Lesions: New Approach to Improve Recognition of Dermoscopic Structures

BACKGROUND: Hypoepiluminescence microscopy (HELM) is a new dermoscopic approach for analysis of pigmented skin lesions (PSLs) after surgical excision. OBJECTIVES: The objective was to verify whether this method could provide additional morphologic information for diagnostic or didactic purposes compared to conventional epiluminescence microscopy (ELM). PATIENTS AND METHODS: Thirty-one PSLs from 30 patients were consecutively evaluated by ELM and, after excision, by HELM. For HELM examination, the lesion was positioned on a glass slide and illuminated from above with a halogen lamp and from underneath with an LED source. All lesions were subsequently examined histopathologically. RESULTS: In 11 of 31 (35.5%) lesions, a typical pigment network, as assessed by ELM, appeared bidimensional with HELM. In 9 lesions (9/31; 29%) ELM showed a gray-blue area, while HELM allowed us to distinguish 5 lesions (5/9, 55.5%) with gray area predominant showing a lichenoid lymphocytic infiltration and few melanophages from the other 4 lesions (4/9, 44,5%) with heavy dermal accumulation of pigmented melanocytes or melanophages where a blue area was clearly visible at HELM. In 9 other cases (29%), ELM analysis revealed a central homogeneous dark brown/black pigmentation that in 7 cases was seen under HELM examination to consist of globules. CONCLUSIONS: HELM is particularly useful in evaluating heavily PSLs or structures located in the reticular dermis.     

False "Melanocytic" Parameters Shown by Pigmented Seborrheic Keratoses: A Finding Which is not Uncommon in Dermoscopy

BACKGROUND: Dermoscopic evaluation of pigmented lesions includes assessment of criteria suggestive of melanocytic proliferation. Dermoscopic diagnosis may be hampered when a nonmelanocytic lesion displays one or more melanocytic features. OBJECTIVE: To evaluate the incidence of misleading dermoscopic features characteristic of melanocytic lesions in pigmented seborrheic keratosis (PSK). METHODS: We evaluated 402 clinically typical PSKs from 138 patients with at least one clinically identifiable PSK. RESULTS: Approximately 10% of PSKs displayed one or more melanocytic features, the most frequent being a "false" pigment network. CONCLUSION: The occurrence of a "false" pigment network in PSK can be misleading in the differential diagnosis of clinically equivocal lesions. A correct diagnosis can only be obtained if all available dermoscopic criteria are appropriately assessed together with the clinical examination.     

Q-开关激光对黄褐斑动物模型黑素细胞病理形态的影响

目的:探讨Q-开光1064nm Nd:YAG激光不同能量照射对黄褐斑动物模型表皮黑素细胞病理形态的影响。方法:用Q-开关1064nm Nd:YAG激光不同能量和频率照射黄褐斑动物模型背部皮肤,分别于激光照射前和照射后不同阶段取材,通过HMB45免疫组化染色法,光镜观察豚鼠表皮黑素细胞的变化。结果:第一次激光照射后即刻可见高能量两组黑素阳性细胞减少,第5次激光照射后即刻可见低能高频组黑素阳性细胞减少。与术前比较,低能量密度低频率照射组黑素细胞阳性细胞数无显著差异。5次治疗后软件分析结果显示,高能高频、高能低频和低能高频组与照射前比较黑素细胞阳性目标个数、平均数密度、平均光密度下降,但平均灰度值上升,差异有统计学意义(P<0.01)。结论:高能量密度Q-开光Nd:YAG激光照射对表皮黑素细胞的影响大于低能量密度,当其超过一定阈值时能高能量高频率可导致黑素细胞的损伤和减少。从而为临床应用Q-开关1064nm Nd:YAG激光治疗色素性疾病提供了实验依据。     

Treatment of Poikiloderma of Civatte Using Intense Pulsed Light Source: 7 Years of Experience

BACKGROUND AND OBJECTIVE The treatment of choice of poikiloderma of Civatte should address both pigmented and vascular lesions at the same time. A broad-spectrum, noncoherent intense pulsed light (IPL) source can be used to obtain this effect. In this study, we investigated the clinical efficacy and side effects of treating this condition with IPL.
MATERIALS AND METHODS A total of 175 patients with poikiloderma of Civatte of the neck and chest were treated with IPL at various settings. The mean age of patients of various skin types (Fitzpatrick I to III) was 49 years. They were subjected to a treatment protocol including three sessions every 3 weeks. At follow-up visit, performed 3 months after the last treatment, clinical improvement was evaluated for all patients by comparing pre- and posttreatment photographs. The patients also scored their overall satisfaction.
RESULTS Clearance of more than 80% of vascular and pigmented components of poikiloderma of Civatte was observed. Minimal and transient side effects occurred in 5% of the patients. No scarring or pigment disturbances were noted after the treatments.
CONCLUSIONS The IPL source can be considered a safe and effective therapeutic option for poikiloderma of Civatte, allowing a marked improvement of vascular and pigmented lesions with minimal side effects.     

Negative Predictive Value of Pigmented Lesion Evaluation by Multispectral Digital Skin Lesion Analysis in a Community Practice Setting

Objective: To determine if the high negative predictive value of a multispectral digital skin lesion analysis that has been previously found in an academic-based trial would be similar in a community-based setting with its expected different distribution of pigmented lesions. Design: Data were collected from patients undergoing routine skin examinations over a one-year period at a community-based practice in Florida. All lesions that were selected for biopsy to rule out melanoma were also imaged with multispectral digital skin lesion analysis prior to biopsy. Histopathological diagnoses and multispectral digital skin lesion analysis results were reviewed and compared with findings from a prior primarily academic center-based multispectral digital skin lesion analysis trial. Setting/participants: Community-based clinical setting in Florida. Measurements: Negative predictive value, sensitivity, and specificity. Results: One hundred thirty-seven consecutive lesions were selected for biopsy and also analyzed via multispectral digital skin lesion analysis. All 21 cases with multispectral digital skin lesion analysis “Low Disorganization” readings were all histologically benign (100% negative predictive value, 95% lower confidence boundary = 96.9%). The negative predictive value and the sensitivity were not significantly different than what was found in the prior academic-based multispectral digital skin lesion analysis trial. Multispectral digital skin lesion analysis also correctly identified all high-risk lesions, which were subsequently confirmed via histology to be one invasive melanoma and 15 moderately dysplastic nevi (100% sensitivity). Specificity with multispectral digital skin lesion analysis was significantly higher than reported in the academic-based multispectral digital skin lesion analysis trial (18% vs. 10%, p=0.02). Conclusion: Because of the high negative predictive value achieved by multispectral digital skin lesion analysis, lesions with readings of “Low Disorganization” may be considered for observation versus biopsy. Similar to what was noted in the academic center setting, multispectral digital skin lesion analysis may help dermatologists reduce the number of unnecessary biopsies while improving diagnostic accuracy.The incidence of melanoma is rising by approximately three percent each year.1 Dermatologists are faced with the challenge of diagnosing melanoma early as survival is indirectly proportional to time prior to intervention. Often, patients present with multiple suspicious pigmented lesions and differentiating which require biopsy from those that should be monitored complicates biopsy decision management for the clinician. In the evolving landscape of healthcare delivery in the United States, it is important to emphasize evidence-based practice that may increase biopsy efficiency. New technologies are emerging as tools for dermatologists to use in identifying suspicious lesions for biopsy and to enhance overall accuracy of biopsy decisions.2A multispectral digital skin lesion analysis (MSDSLA) (MelaFind®; MELA Sciences, Inc.) device is a noninvasive objective instrument that can aid dermatologists in determining which suspicious pigmented skin lesions should be biopsied to rule out melanoma.3 MSDSLA images and analyzes a pigmented skin lesion across 10 spectral bands of light (430-950nm) from the skin surface to 2.5mm in depth. Automated computerized analysis evaluates 75 unique features of pigment distribution within an atypical lesion to determine the level of morphological disorder and generate a classifier score (CS).3 A CS greater than or equal to 0 is considered to have “high” disorganization and scores less than 0 have “low” disorganization.The safety and effectiveness of MSDSLA were originally established from data analyzing 1,632 skin lesions collected by physicians at pigmented skin lesion centers of several major academic centers.4 In this primarily university-based study, a low disorganization finding was associated with a 98 percent negative predictive value (NPV).4 However, the frequency and distribution of pigmented lesions that are encountered at high-risk pigmented lesion clinics would be expected to be different than what is experienced in a community-based setting. The purpose of this study was to determine if the NPV using MSDSLA is similar in a community-based setting to what was described in the primarily academic pigmented lesion center study, thereby enabling the community-based clinician to choose to potentially follow versus biopsy those lesions identified as having low disorganization.     

Q-开关1064nm激光治疗黄褐斑临床疗效的定量评价

目的：应用VISIA皮肤测试仪对Q-开关1064nm激光治疗黄褐斑的临床效果进行定量评价。方法：随机选取2010年5月～2010年10月在我激光美容中心进行黄褐斑激光治疗的患者72例,应用Medlite C8 Q-开关激光,以1064nm波长,6～8mm光斑照射面部,每周1次,10次为一个总疗程,用VISIA皮肤测试仪和临床照片对患者色素斑进行定量分析和评价。结果：治疗72例,基本治愈28例（38.9%）,显效34例（47.2%）,好转10例（13.9%）,无效0,总有效率为86.1%,患者耐受性好,无明显副作用。VISIA皮肤测试显示治疗后色素斑相对于治疗前绝对数值平均下降35.2±8.4,相对分值下降1.625±0.279,相对比率平均提高（38.6±6.2）%,有显著性差异（P〈0.01）。结论：Medlite C8 Q-开关激光治疗黄褐斑安全有效,应用VISIA皮肤测试仪检测黄褐斑患者的定量分析,可以作为Q-开关1064nm激光治疗黄褐斑的一个定量衡量标准,在诊断、指导治疗方法和疗效评估上都有一定意义。     

Treatment of superficial cutaneous pigmented lesions by melanin-specific selective photothermolysis using the Q-switched ruby laser.

The Q-switched ruby laser at 694 nm, a wavelength well absorbed by melanin relative to other optically absorbing structures in skin, causes highly selective destruction of pigment-laden cells. In addition, the 20-nsec pulse duration produced by this laser approximates the thermal relaxation time for melanosomes, thereby confining the energy to the target. This new laser system produces clinically significant fading of superficial cutaneous pigmented lesions in patients, without complications such as hypertrophic scarring or changes in the normal skin pigmentation, often seen with conventional laser systems or other therapeutic methods. In ongoing clinical trials at our facility, excellent results have been obtained for lentigines, café-au-lait macules, nevus spilus, Becker's nevi, and ephelides (freckles), without skin scarring or textural or permanent pigment changes. The purpose of this report is to (1) describe the theoretical considerations that can be understood and used by a nonlaser-oriented practitioner involved in achieving selective removal of superficial cutaneous pigmented lesions, and (2) describe the practical application of the device to the clinical management of patients.     

Treatment of Poikiloderma of Civatte with an Intense Pulsed Light Source

BACKGROUND: Effective treatment of poikiloderma of Civatte combines elimination of both the vascular and pigmented components simultaneously. A broad spectrum, noncoherent, intense pulsed light (IPL) source delivers multiple wavelengths with software controlled pulse durations and sequencing, which permits treatment of both vascular and pigmented lesions simultaneously. OBJECTIVE: To determine response and side effects of poikiloderma of Civatte of the neck and chest when treated by IPL. METHODS: One hundred and thirty-five patients randomly selected with typical changes of poikiloderma of Civatte on the neck and/or upper chest were treated with one to five treatments using IPL. RESULTS: Clearance of more than 75% of telangiectasias and hyperpigmentation comprising poikiloderma was observed. The incidence of side effects was 5%, including pigment changes. In many cases, improved skin texture was noted both by physician and patient. CONCLUSION: IPL is an effective mode of therapy for poikiloderma of Civatte. It offers a reduction of pigment and telangiectasias with a low risk profile. Additional benefits include subjective changes of improvement in skin texture.     

Polarization Color Imaging System for On-Line Quantitative Evaluation of Facial Skin Lesions

BACKGROUND A number of studies have been performed for accurate evaluation of chromophores in skin lesions. Qualitative methods are subjective and cause user-dependent error in evaluation. Quantitative methods have limitations for widely distributed skin lesions due to poor spatial resolution, potential skin blanching, and difficulty in relocating identical sites for subsequent measurements and analysis.
OBJECTIVE The objective was to develop a new imaging modality that provides both qualitative and quantitative methods to evaluate widely distributed skin lesions.
METHODS We have developed a prototype polarization color imaging system named "DermaVision," which provides quantitative on-line image analysis of polarization color images. Herein, we describe the hardware and software of DermaVision in terms of its performance and usefulness for dermatologic applications.
RESULTS Polarization color images were successfully acquired from patients with vascular or pigmented skin lesions. The erythema and melanin index images were successfully computed and quantitatively confirmed the degree of erythema and pigmentation in the skin lesions.
CONCLUSION We believe that DermaVision can be a useful auxiliary tool in dermatology because it simultaneously provides both qualitative and quantitative images of skin lesions.