黄褐斑的激光治疗新进展

黄褐斑是一种面部色素性疾病,病因复杂,治疗困难。目前临床上治疗黄褐斑的方法包括口服药物、外用药物、激光等,往往采用多种方法联合治疗。随着选择性光热作用原理的提出,激光技术的快速发展,激光治疗黄褐斑取得了很大进展。该文就皮秒激光、非剥脱性点阵激光、剥脱性点阵激光、Q开关激光、强脉冲光等治疗黄褐斑的研究进展进行综述。     

激光和强脉冲光治疗黄褐斑的进展

黄褐斑是常见的色素沉着损容性皮肤病,发病率高,治疗困难,易复发,影响患者心身健康［1］。虽然黄褐斑治疗方法多样,但均不能达到满意疗效。近年来,激光和强脉冲光利用其选择性光热原理,已普遍用于黄褐斑治疗［2］。激光治疗黄褐斑的机器、模式、疗程、终点选择各有不同［3-4］,现就PubMed上检索到的相关研究进行分析。从时间上,2005年以前是初步探索阶段,2005年以后是争鸣阶段。从激光类型上,532 nm、694 nm、755 nm、1064 nm的Q开关激光,剥脱性和非剥脱性点阵激光运用最为普遍。有研究认为,激光和强脉冲光治疗黄褐斑安全有效,也有研究认为无效易复发,且有色素脱失等不良反应。因此,就黄褐斑激光和强脉冲光治疗的临床疗效和安全性分析如下……     

红宝石点阵激光联合强脉冲光治疗黄褐斑102例疗效评价

目的:评价红宝石点阵激光联合强脉冲激光治疗黄褐斑临床疗效及安全性。方法:102例黄褐斑患者给予Q开关红宝石点阵激光治疗,能量密度2.5~3.5 J/cm2,2周后,行强脉冲光治疗。每4周治疗1次,共4次。治疗结束前后对患者进行黄褐斑皮损面积和严重程度指数(MASI)评分,记录复发情况及不良反应。治疗结束后6个月随访判定结果。结果:痊愈5例(4.90%),显效69例(67.65%),好转26例(25.49%),无效2例(1.96%),总有效率72.55%。未见明显不良反应。结论:红宝石点阵激光联合强脉冲光治疗黄褐斑安全、有效。     

黄褐斑的物理与化学治疗

黄褐斑的理化治疗包括强脉冲光、射频技术、激光及化学剥脱等.理化治疗作为黄褐斑治疗中的新技术,因其治疗周期短、有效率高受到越来越多的重视,并取得一定的进展.其中,强脉冲光、短波长激光及化学剥脱适合于表皮型黄褐斑的治疗;而混合型及真皮型黄褐斑的治疗可选择点阵激光,长波长激光联合短波长激光、剥脱性激光和强脉冲光.     

黄褐斑的物理与化学治疗

黄褐斑的理化治疗包括强脉冲光、射频技术、激光及化学剥脱等.理化治疗作为黄褐斑治疗中的新技术,因其治疗周期短、有效率高受到越来越多的重视,并取得一定的进展.其中,强脉冲光、短波长激光及化学剥脱适合于表皮型黄褐斑的治疗;而混合型及真皮型黄褐斑的治疗可选择点阵激光,长波长激光联合短波长激光、剥脱性激光和强脉冲光.     

黄褐斑的物理与化学治疗

黄褐斑的理化治疗包括强脉冲光、射频技术、激光及化学剥脱等.理化治疗作为黄褐斑治疗中的新技术,因其治疗周期短、有效率高受到越来越多的重视,并取得一定的进展.其中,强脉冲光、短波长激光及化学剥脱适合于表皮型黄褐斑的治疗;而混合型及真皮型黄褐斑的治疗可选择点阵激光,长波长激光联合短波长激光、剥脱性激光和强脉冲光.     

Q开关Nd:YAG激光联合强脉冲光治疗色素性皮肤病的临床效果

目的研究Q开关Nd:YAG激光联合强脉冲光治疗色素性皮肤病的效果。方法选择2016年1月~2017年10月本院色素性皮肤病患者82例,依据治疗方法分为观察组、对照组各41例,分别接受Q开关Nd:YAG激光联合强脉冲光治疗、单一强脉冲光治疗,比较两组效果。结果观察组总有效率为73.17%,对照组总有效率为46.34%,P0.05;观察组不良反应发生率为7.32%,对照组发生率4.88%,P0.05。结论 Q开关Nd:YAG激光联合强脉冲光治疗色素性皮肤病能够提升临床治疗效果,保证治疗安全性,可在临床推广。     

强脉冲光单独或联合其他疗法治疗黄褐斑的研究进展

【摘要】 黄褐斑病因复杂,目前治疗手段较多,但均无确切、满意的疗效。近年来,强脉冲光治疗黄褐斑取得了良好的疗效。本文综述近年来单用强脉冲光及联合激光、外用药和系统用药治疗黄褐斑取得的进展。     

黄褐斑的治疗进展

黄褐斑是一种获得性色素增加性皮肤病,病因复杂,治疗困难。外用药是黄褐斑治疗的首选,单用4%氢醌乳膏和三联疗法（4%氢醌乳膏+0.01%氟轻松+0.05%维A酸乳膏）为一线治疗方案,目前外用氨甲环酸治疗黄褐斑被证实安全有效,苯丙氨酸、丁雷锁辛也有一定疗效。外用木质素过氧化物酶、锌、西酸模精华、二乙酰伯尔定碱及转化生长因子β1仿生寡肽68、氟他胺等是近年的新方法。联合口服氨甲环酸能增加疗效。Q开关激光治疗黄褐斑疗效明显,但易复发和色素沉着。强脉冲光、点阵激光尚缺乏大样本研究,CO2激光和铒激光疗效显著,但极易造成亚洲患者的炎症后色素沉着,故不适于亚洲人群。顽固性黄褐斑患者可考虑化学或物理剥脱治疗,皮肤磨削术使97%患者的黄褐斑获得了永久性清除。     

激光与强脉冲光治疗黄褐斑进展

<正>激光与强脉冲光去除色素颗粒是基于选择性光热作用。研究认为激光与强脉冲光治疗黄褐斑的机理可能与抑制血管内皮细胞活性,减少血管内皮生长因子过度表达有关。近年来,激光与强脉冲光技术治疗黄褐斑取得了不错的进展,但真正达到治愈的目的有着一定的难度,且部分患者     

Laser and intense pulsed light management of couperose and rosacea

Management of couperosis and rosacea has been totally renewed by laser and vascular laser techniques, with efficacy targeted on the telangiectases and to a lesser extent on the erythrosis. Laser management of hypertrophic rosacea or rhinophyma depends on surgical treatment with decortication, continuous CO(2) ablative laser or Erbium, fractionated at high power, then vascular laser treatment for the telangiectases: lasers with pulsed dye, KTP, or pulsed lights for red laser telangiectases and long pulse Nd-Yag laser for blue telangiectases. For papulopustular rosacea, vascular laser treatment (pulsed dye and KTP) and intense pulsed light will be begun once the inflammation has been treated. The major indication for vascular lasers and intense pulsed light is found in erythematotelangiectatic rosacea, with high efficacy for the telangiectases. Diffuse erythrosis is difficult to treat, requiring a high number of laser and/or intense pulsed light sessions.     

Laser and intense pulsed light management of couperose and rosacea

Management of couperosis and rosacea has been totally renewed by laser and vascular laser techniques, with efficacy targeted on the telangiectases and to a lesser extent on the erythrosis. Laser management of hypertrophic rosacea or rhinophyma depends on surgical treatment with decortication, continuous CO(2) ablative laser or Erbium, fractionated at high power, then vascular laser treatment for the telangiectases: lasers with pulsed dye, KTP, or pulsed lights for red laser telangiectases and long pulse Nd-Yag laser for blue telangiectases. For papulopustular rosacea, vascular laser treatment (pulsed dye and KTP) and intense pulsed light will be begun once the inflammation has been treated. The major indication for vascular lasers and intense pulsed light is found in erythematotelangiectatic rosacea, with high efficacy for the telangiectases. Diffuse erythrosis is difficult to treat, requiring a high number of laser and/or intense pulsed light sessions.     

Conversion of aesthetic lasers and intense pulsed light sources into inherently eye‐safe units

BACKGROUND: Laser systems used in aesthetic treatments pose a serious risk to the eyes of bystanders and equipment operators. Although much safer than lasers, intense pulsed light (IPL) sources are also not without risk.

OBJECTIVE: To present a technology that can convert most lasers and IPL units used in aesthetic clinics into inherently eye‐safe devices not requiring the use of protective eyeglasses, thus making them Class I devices. With the exception of Q‐switched lasers, this new technology also dramatically reduces the potential hazards of lasers that do not attain Class I level to below that attributed to flashlamps. A device that eliminates the annoying glare generated by the reflection of pulsed light from the skin is also presented.

MATERIALS AND METHODS: The new eye‐safe technology is based on the attachment of a highly efficient wide‐angle forward scattering optical diffuser to the distal end of the laser delivery handpiece. This device is used in contact with the treated area without modification of the conventional treatment parameters and preserves clinical efficacy. The handpiece is designed to act as an eye‐safe, extended diffusing light source complying with Class I eye safety standards in most laser types. The technology also makes IPL devices safer by reducing the radiance of the flashlamp, which is hazardous when viewed directly by operators or bystanders. Skin glare is also eliminated by a liquid crystal, glare‐free window activated in synchronization with the treatment pulses.

RESULTS: Clinical hair removal results with an 80?degree diffuser did not reveal any difference when compared with results obtained with the original laser source. The incorporation of a diffuser in an IPL unit has not modified its clinical efficacy.

CONCLUSION: With the exclusion of Q‐switched lasers, it is possible to convert a large number of lasers and IPL units utilized in aesthetic treatments into inherently eye‐safe units, thereby considerably enhancing the comfort and safety of aesthetic clinics without sacrificing clinical efficacy.     

Q开关Nd:YAG激光与强脉冲光对鼠皮肤热休克蛋白70表达的影响

目的:确定Q开关1064 nm Nd:YAG激光与强脉冲光(IPL)对Wistar大鼠皮肤热休克蛋白70(HSP70)表达的影响.方法:Wistar大鼠20只,背部皮肤脱毛,平均分成3部分:近头侧区为正常对照组,中间区为IPL组,近尾侧区为YAG组.于照射后1天、1周、4周取大鼠皮肤标本,免疫组化技术检测HSP70的表达.结果:免疫组化显示:Q开关1064 nm Nd:YAG激光和IPL照射后1周,HSP70表达最为显著;照射后4周,HSP70表达下调,IPL组表达与正常对照组无差别,YAG组仍较正常对照组表达增强(P＜0.05);两光照组间于照射后1天、1周和4周HSP70表达差别有统计学意义(P＜0.05).结论:HSP70的表达强度与光照后组织热损伤的程度和深度有关,Q开关1064 nm Nd:YAG激光对大鼠皮肤的非剥脱性嫩肤作用较IPL强且持久.     

Tattoo removal – state of the art

Tattooing has been around since the early beginnings of modern civilization. The discovery of selective photothermolysis at last has made it possible to remove tattoos without leaving a scar. Q‐switched neodymium: yttrium‐aluminum‐garnet, alexandrite, and ruby lasers with pulse durations in the nanosecond domain fulfill this need. Argon or cw‐CO₂ lasers as well as intense pulsed light sources should not be used since they often produce significant scarring. This article provides an overview of current laser systems.Developments leading to new tattoo inks, feedback systems to detect the absorbance characteristics of tattoo inks, dermal clearing agents, and perhaps even lasers with shorter pulse‐durations might improve the results in the future.