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.     

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。     

A型肉毒毒素联合Lux1540 nm非剥脱点阵激光治疗眶周皱纹的临床疗效

目的:探讨A型肉毒毒素联合Lux1540 nm非剥脱点阵激光治疗眶周皱纹的临床疗效。方法:选择年龄30~60岁有眶周皱纹患者60例,随机分为3组,A组给予A型肉毒毒素注射,B组给予Lux1540 nm非剥脱点阵激光治疗,C组给予A型肉毒毒素注射联合Lux1540 nm非剥脱点阵激光治疗。每例患者在治疗前,治疗后14 d、1、3、6个月随访并行疗效评估。结果治疗1个月后,三组患者眶周皱纹、纹理、弹性、水分均有所改善,与治疗前比较,差异均有统计学意义(P值均<0.05)。肉毒毒素注射联合Lux1540 nm非剥脱点阵激光的C组患者,其皱纹、纹理、弹性、水分的远期效果改善更加明显。结论 A型肉毒毒素联合Lux1540 nm非剥脱点阵激光治疗可同时改善眶周的皱纹和纹理,同时具有紧致眶周皮肤的作用,是眶周皮肤年轻化治疗的理想治疗方案。     

1565 nm非剥脱点阵激光联合糖皮质激素治疗增生性瘢痕疗效评价

目的：评价1565 nm非剥脱点阵激光联合糖皮质激素治疗增生性瘢痕患者的疗效。方法：将增生性瘢痕患者随机分成对照组和观察组，观察组给予醋酸曲安奈德注射和1565 nm非剥脱点阵激光治疗(能量10～70 mJ，能量密度50～500 J/cm2),对照组仅给予醋酸曲安奈德注射,利用温哥华瘢痕评分量表(Vancouwer scar scale，VSS)对瘢痕的色泽、质地、厚度等进行评分。结果：共收集患者60例，对照组和观察组各30例，观察组和对照组总体有效率为93.4%和70%，差异具有统计学意义(P<0.05)。观察组VSS评分平均值为2.18低于对照组的3.68，差异具有统计学意义(P<0.05)。两个组均未见明显不良反应。结论：1565 nm非剥脱点阵激光联合糖皮质激素注射治疗增生性瘢痕的疗效优于单用糖皮质激素注射。     

点阵激光治疗黄褐斑进展

点阵激光是皮肤激光美容领域的一种新技术,近年来在黄褐斑的治疗中显示出良好的前景.点阵激光的作用原理是局灶性光热作用,是选择性光热作用的一个重要拓展和延伸.点阵激光可分为非剥脱性点阵激光和剥脱性点阵激光,对黄褐斑有一定的疗效,改善程度不一,有的甚至加重,其疗效与治疗参数的选择、皮肤类型、术后护理、黄褐斑类型等有关.不良反应主要为短暂性红斑、水肿、灼热和疼痛感等,患者可耐受,但炎症后色素沉着发生率相对较高.     

点阵Er:YAG激光照射豚鼠皮肤后的组织学变化

目的:评价点阵Er:YAG激光连续多脉冲照射对豚鼠皮肤的组织学影响。方法:使用点阵Er:YAG激光连续15个脉冲照射脱毛后的豚鼠背部皮肤,取照射后1 h、1 d、2 d、3 d、5 d、7 d、15 d及30 d的照射侧和对照侧皮肤,应用HE染色、LDH酶组织化学染色和Masson染色进行组织学观察。结果:点阵Er:YAG激光连续多脉冲照射豚鼠皮肤后,皮肤组织出现一系列点阵排列的局灶性锥状气化剥脱微损伤。照射后1～7 d微损伤区皮肤产生炎症反应,表皮细胞上皮化,炎症和坏死组织形成痂皮脱落;8～30 d局部真皮内胶原新生、重塑,照射后15 d胶原较未照射侧明显增多。结论:点阵Er:YAG激光连续多脉冲照射豚鼠背部皮肤可以有效的刺激真皮局灶性胶原增生。     

激光治疗痤疮瘢痕的研究进展

痤疮是常见病之一,多数人曾患有不同程度的痤疮,少数患者可遗留痤疮瘢痕,目前尽管有很多方法,包括手术、激光和化学剥脱等可治疗痤疮瘢痕,但其治疗仍是棘手难题.近年来点阵激光的开展给痤疮瘢痕治疗带来一定的突破.从痤疮瘢痕的流行病学、病因、临床特征和各种激光器(包括剥脱性激光、非剥脱性激光和点阵激光)在痤疮瘢痕的临床应用、优缺点和不良反应等方面进行阐述.     

点阵激光改善皮肤光老化作用机制的研究进展

点阵激光已广泛用于治疗各种皮肤疾病,包括皮肤光老化、痤疮瘢痕和色素性疾病等,其利用点阵光热分解的原理,点阵激光作用皮肤后形成微治疗区,周围仍见正常组织,角质形成细胞快速从周围迁移、增殖和上皮化,从而促进快速愈合,停工期短。主要概述点阵激光改善皮肤光老化的研究进展,从组织学改变和分子水平作用机制进行阐述。     

局灶性光热作用技术治疗光老化研究进展

光老化主要表现为皮肤皱纹增加、角质增厚、微循环变化以及色素异常改变.局灶性光热作用技术是激光治疗光老化的新技术.该技术主要有非气化型局灶性光热作用技术和气化型局灶性光热作用技术,其中气化型光热作用技术主要有点阵CO_2技术和点阵铒激光技术.从治疗的组织学改变、临床应用评价和不良反应三方面概述非气化型局灶性光热作用技术、点阵CO_2激光技术和点阵铒激光技术治疗皮肤光老化的研究进展.     

Fractionated CO2 laser skin rejuvenation

Fractional photothermolysis has been reported in the literature to improve both the pigmentary and textural changes associated with photoaging. The objective of the study was to review the literature of non-ablative fractional laser (NAFL) and ablative fractional laser (AFL) resurfacing for the treatment of photoaging. This is a review of the Medline literature evaluating NAFL and AFL for photoaging. Review of the literature supports the use of NAFL and AFL as safe and effective treatments for photoaging. It is likely that the controlled, limited dermal heating of fractional resurfacing initiates a cascade of events in which normalization of the collagenesis/collagenolysis cycle occurs. The advent of fractionated resurfacing for the treatment of photoaging is a significant advance over ablative laser resurfacing treatments, which were complicated by prolonged erythema, delayed onset hypopigmentation, and scarring.     

The use of 1540 nm fractional photothermolysis for the treatment of acne scars in Asian skin: a pilot study

Background: Various modalities have been used to treat acne scars, but limited efficacy and considerable side effects have restricted their proper use. Recently, a new-generation fractional photothermolysis modality has been introduced that has deeper penetrating ability; however, a 1540 nm fractional photothermolysis study has not yet been performed.
Objectives: To evaluate the efficacy and safety of 1540 nm fractional photothermolysis for the treatment of acne scars in Asian skin.
Methods: Sixteen volunteers (Fitzpatrick skin types III–IV) with mild to moderate acne scars were enrolled. Acne scar lesions were treated with 1540-nm fractional photothermolysis (Starlux^™ 1540). Three treatment sessions were performed for each patient 4 weeks apart. Outcome assessments included the following four methods: (1) clinical evaluation of the photographs that were taken before and after the treatment; (2) comparison of the quality of life (QOL) of the patients before and after the treatment; (3) patients' satisfaction with the treatment; and (4) comparison of the quantity of collagen and elastic fibers in the skin biopsies before and 12 weeks after the last treatment.
Results: A mild to moderate clinical improvement was observed in most of the patients. Moreover, the QOL of all the patients improved, and all of them were satisfied with the results of the treatment. Significant collagen and elastic-fiber increases were also observed after the treatment, and side effects were limited to transient erythema and edema, which occurred in 50% of the patients. No severe side effect was observed.
Conclusions: 1540 nm fractional photothermolysis is an effective and safe method for improving acne scar, even in Asian skin.     

Fractional photothermolysis treatment for resistant melasma in Chinese females

Background: Melasma is a common disorder of pigmentation which is common in women of Asian and Latina descent. Melasma lesions are resistant to numerous laser therapies, but have responded well in clinical studies to fractional photothermolysis. Objective: To determine whether Chinese women with resistant melasma will respond to fractional photothermolysis. Methods: Six female patients &lpar;Fitzpatrick skin types III-IV&rpar; were treated with fractional photothermolysis at approximately 4 week intervals. Three to four treatments were performed for each patient. Before and after photos were taken of each patient in order to identify the degree of improvement of the pigmented lesions treated. Results: All patients who participated in the study experienced at least 20% improvement in the appearance of their melasma lesions. Three patients obtained 50% improvement, two obtained 30% improvement, and one obtained 20% improvement. Conclusion: Fractional photothermolysis is a useful treatment modality for Chinese women who have resistant melasma.     

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.     

Syringoma of the face treated with fractional photothermolysis

Abstract

We experienced that two Japanese women diagnosed with syringoma, confirmed by a punch biopsy, were successfully treated with fractional resurfacing. Both clinical cases have had positive results after only a few treatments, with high patient satisfaction, not only for the improvement of syringoma, but also for the improvement of aging skin, and with no side effects. From that aspect, laser treatment with fractional photothermolysis may be considered to be one of the effective treatment methods for syringoma. Although fractional photothermolysis was originally developed for an aesthetic purpose, it also can be utilized for intractable skin disease, as demonstrated by taking the concept of fractional photothermolysis and the results from this study with skin biopsy.     

Innovationen in der dermatologischen Lasertherapie

Dermatologic laser therapy is a rapidly-changing field with many new innovations. One of the most important is the introduction of fractional photothermolysis. This method is established for skin rejuvenation and acne scars; both the original non-ablative devices and newer ablative ones are available. While its side effects and the patient’s downtime are considerably less than with ablative skin resurfacing, its efficacy is much better than non-ablative laser skin rejuvenation. This approach is also effective for melasma and other forms of hyperpigmentation in some patients. Successful reports exist also for treating other, more infrequent dermatoses. Another new procedure is laser lipolysis. It can be used as an adjunct to classical liposuction or as laser lipolysis alone. Fat lysis is achieved by laser energy via fibers that are inserted in the subcutaneous fat, and the additional heating of dermal tissue may lead to the reduction of side effects such as bleeding and to reduction of skin laxity. Nevertheless, the superiority of laser lipolysis to classical liposuction techniques is not yet established, and the ideal wavelengths and treatment parameters are not yet fully clear. There have been improvements in the therapy of vascular lesions, especially the use of longer, infrared wavelengths. In addition, there is early information on experimental therapeutic approaches for diseases normally not amenable to laser therapy such as onychomycosis, hemorrhoids and allergic rhinitis.     

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.     

Treatment of acne scarring with fractional CO2 laser

Abstract

Background: Fractional ablative CO₂ laser therapy is based on the theory of fractional photothermolysis. It can be effective in treating acne scars in a less invasive fashion than conventional ablative CO₂ laser therapy. Objective: In this clinical study, the safety and efficacy of a novel CO₂ fractional ablative laser was investigated for the treatment of facial atrophic acne scarring in Chinese individuals. Materials and methods: A total of 31 patients (11 females, 20 males, Fitzpatrick skin phototypes III–IV) with facial acne scarring received three sequential fractional treatments over a 6-month period. Outcome measurements included blinded evaluations of before and after photographs by two physicians at 3 and 12 months after the final treatment. Global improvement was noted as well as any untoward events. Results: At the 12 months follow-up time period, 12.9% of the patients showed excellent improvement in their acne scars, while 38.71% noted good to fair results. The clinical response at the 12-month follow-up visit tended to be better than at the 3-month follow-up visit, but was not statistically significant. Four patients experienced post-treatment and transient PIH but three patients were noted to have prolonged erythema. There was no evidence hypopigmentation or worsening of the scarring in any of the study patients. Conclusion: This high-energy pulsed and cool-scanned fractional ablative CO₂ laser system is safe and effective for facial atrophic acne scarring. Improvement in scarring was noted in the majority of patients with minimal discomfort and minimal downtime. Continued improvement over time is also an important clinical finding.     

A new multi-modal fractional ablative CO2 laser for wrinkle reduction and skin resurfacing

Abstract

Background: The concept of fractional delivery modality of the energy with both ablative and non-ablative devices is now well known and accepted as an effective method to attain significant aesthetic improvements on facial aging skin. A new, multi-modal, fractional, ablative CO₂ laser that can create, using same scanner/handpiece, deep columns in addition to superficial ablation has been recently proposed and therefore investigated. Method: Twenty-four patients were enrolled in this evaluation. Each of them received one multi-modal, fractional ablative treatment. Patients were clinically and photographically evaluated at baseline and 6 months after the procedure. The degree of photoaging and the efficacy of treatment were evaluated using a VAS five-point scale of some skin features. A 3D images comparison was furthermore performed to objectify the improvements. Results: For all of the analysed skin features of photodamage a significant, statistical improvement was obtained. The data collected with the 3D system demonstrated an average improvement of 42% of the wrinkles and an average improvement of the melanin variation of 40.1%. Conclusions: The multi-modal approach with a single handpiece allows obtaining good outcomes with a very low incidence of adverse effects and a short downtime.     

A fractional 2940 nm short-pulsed,erbium-doped yttrium aluminium garnet laser is effective and minimally invasive for the treatment of photodamaged skin in Asians

Abstract

Background: Although ablative fractional laser for the facial photodamaged skin was effective and safe, there have been only limited reports regarding the efficacy and safety of fractional Er:YAG laser treatments for photodamaged facial skin in Asians. Objective: Our objective was to assess the efficacy and safety of the Er:YAG laser (2940 nm) using the ‘‘ablative’’ fractional resurfacing mode to treat photodamaged facial skin. Methods: A total of 29 Korean patients were treated for photodamaged facial skin using a fractional Er:YAG laser. The number of treatments was mean 2.3 sessions at two-week intervals. Independent investigators assessed the efficacy using standardized photographs. The patients’ satisfaction rate was also evaluated. Results: For dyspigmentation, 62.5% of the treated patients showed improvement greater than 26%. Regarding wrinkles, 50% of the treated patients showed improvement greater than 26%. All patients showed various degrees of improvement in skin laxity. Assessing the overall features, 62.5% of the study subjects showed improvement greater than 26%, and most of them (91.7%) reported that their subjective satisfaction rate was above ‘slight satisfaction’. Downtime accounted for approximately one week in most patients. Conclusions: A fractional Er:YAG laser can deliver an effective and minimally invasive treatment for photodamaged facial skin in Asians.