不同激光和强脉冲光治疗雀斑的应用及进展

雀斑是一种与遗传、日晒、内分泌异常有关的色素增加性皮肤病,组织病理为表皮基底层色素颗粒增多,但黑素细胞并不增多。因主要发生在面部,有碍美观,患者求治心切。临床上以往多用冷冻、磨削、化学剥脱、烧灼等方法治疗,如掌握不当易产生皮肤瘢痕、色素改变等不良反应。选择性光热作用理论的提出使得清除皮肤中黑素这样的靶目标成为可能,同时使得色素性皮肤病的治疗取得了明显进展。本文参考近年来不同激光和强脉冲光治疗雀斑的相关文献就其应用及进展综述如下。     

黄褐斑的激光及强脉冲光治疗进展

黄褐斑是一种色素沉着性皮肤病，多见于中青年女性面部，发病前通常无局部炎症和外伤史，病因病机复杂，目前无十分理想的治疗方法。选择性光热作用原理的提出，为医学美容激光治疗多种面部色素性疾病带来了新的契机，以往令人类束于无策，严重影响容貌的太田痣、咖啡斑等面部皮肤色素性疾病，得到近乎完美治疗的效果。近年来尝试运用激光和强脉冲光的选择性光热作用治疗黄褐斑取得了一些进展，本文就此综述如下。     

优化强脉冲光治疗色素性皮肤病的临床疗效观察

目的 探讨优化强脉冲光(optimal pulse technology,OPT)治疗色素性皮肤病的疗效及安全性.方法 采用波长515～1200 nm的OPT治疗仪治疗162例色素性皮肤病,一般治疗3～4次为1疗程,每次间隔3～4周.治疗后观察临床疗效及不良反应,进行评价,并做好记录和随访.结果 162例经治疗后,色素性病变逐渐消褪,总有效率达96.91%.其中雀斑、雀斑样痣、老年斑疗效较为显著.结论 OPT是新一代强脉冲光技术,用于治疗色素性病变,与传统方法比较副作用少,皮肤损伤小,且效果显著,复发率较低,值得临床上推广应用.     

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560nm，治疗脉宽为2．4～6ms，每个光斑2～3脉冲，能量密度24～36J／cm^2。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。     

强脉冲光联合调Q激光治疗色素增生性皮肤病

目的探讨强脉冲光联合调Q激光疗法对面部色素增生性皮肤病的疗效及安全性。方法根据患者面部色素性疾病的特点,对225例FitzpatrickⅢ、Ⅳ型皮肤的色素细胞增生性皮肤病患者,采用560nm强脉冲光联合调Q532nm激光治疗,首先使用560nm强脉冲光,能量密度30～40J／cm2的光子嫩肤治疗,每月1次,3个月后观察疗效。对于改善不品著的脂溢性角化斑、咖啡斑及眼睑、口唇周围残留的雀斑等,再使用调Q532nm激光,施行局部针对性治疗,能量密度70J／cm2。于激光治疗后2个月,对皮损的改善和满意度进行评估并记录不良反应。结果90％患者的雀斑、咖啡斑、脂溢性角化斑的色素均有50％～70％不同程度的消退,同时毛细血管扩张、毛孔粗大、细小皱纹均达到了60％以上的程度的改善。主要并发症为暂时性红斑和水疱。结论560nm强脉冲光联合调Q激光治疗面部色素增生性皮肤病安全有效,同时能有效改善肤质。     

联合强脉冲光和射频治疗面部雀斑的临床研究

目的探讨联合强脉冲光和射频对雀斑的临床疗效及安全性。方法对150例患者进行临床研究，采取联合强脉冲光和射频治疗，每21d治疗1次，共3～5次，治疗前后观察疗效。结果150例雀斑患者经过3-5次治疗后，52例痊愈，58例显效，34例好转，6例无效，显效率为73．3％，有效率为96．0％。结论联合强脉冲光和射频对雀斑治疗疗效显著，安全性高，值得临床推广应用。     

联合强脉冲光和射频治疗面部雀斑的临床研究

目的探讨联合强脉冲光和射频对雀斑的临床疗效及安全性。方法对150例患者进行临床研究,采取联合强脉冲光和射频治疗,每21d治疗1次,共3~5次,治疗前后观察疗效。结果150例雀斑患者经过3~5次治疗后,52例痊愈,58例显效,34例好转,6例无效,显效率为73.3%,有效率为96.0%。结论联合强脉冲光和射频对雀斑治疗疗效显著,安全性高,值得临床推广应用。     

强脉冲光治疗面部色素性病变128例

目的：探讨强脉冲光（IPL）对面部色素性病变的治疗效果.方法：采用波长为560nm和640nm的IPL Qnautum SR光子嫩肤仪治疗128例面部色素性病变患者,治疗4～6次,每次时间间隔为2～5周,每位患者对比拍照、记录参数并进行临床疗效评估.结果：128例患者中各种病变的显效率分别为：雀斑65.9%（56/85）,痤疮后色素沉着斑66.7%（12/18）,老年斑71.4%（10/14）,咖啡斑40%（2/5）,黄褐斑效果不明显.结论：IPL对雀斑、痤疮后色素沉着斑、老年斑有良好的疗效.     

激光和强脉冲光脱毛的应用及进展

体毛过多或浓重是近年来逐渐受到关注的问题,激光技术在此领域的应用使这一难题得到了极大程度的解决。激光脱毛技术基于选择性的光热动力学原理,具有方便快捷,安全高效,效果永久性等特点。本文参考近年来不同激光和强脉冲光脱毛的相关文献,就其近期的应用和进展综述如下。     

激光与强脉冲光治疗黄褐斑进展

<正>黄褐斑(Melasma)是一种发生于颜面部的色素代谢障碍性皮肤病,多见于中青年女性,是临床常见的皮肤病之一。由于现代生活压力的增加以及各种环境因素的改变,黄褐斑的发病率呈逐年上升的趋势。根据Wood灯照射色素积聚的部位,临床上将黄褐斑分为三种组织学类型:表皮型、真皮型和混合型[1]。本病的发病机制尚未完全明确,可能与遗传、药物、紫外线辐射、内分泌、局部微生态、氧自由基等因素有关[2-3],这些因素会引起黑素细胞的生成     

Diagnosis and treatment of pigmentary disorders in Asian skin

Individuals of Asian heritage are predisposed to congenital and acquired pigmentary disorders. Cosmetic enhancement is frequently the primary treatment goal for these benign lesions. Accurate diagnosis of the nature of the pigmentary disorder is fundamental for administering safe and effective therapy. Before the advent of modern laser technology, such reported treatments as cryotherapy, dermabrasion, chemical peeling, and surgical excision resulted in unpredictable results. This article focuses on the diagnosis of disorders of pigmentation in Asian patients and reviews laser and light treatment modalities.     

激光与强脉冲光对皮肤光老化作用机制研究进展

老化和日光损伤皮肤的临床特征包括皱纹、色素异常和皮肤萎缩,组织学上表现为表皮和真皮有序结构的缺失,表皮角变平,表皮下基底带Ⅳ型和Ⅶ型胶原减少,真皮厚度下降,紫外线在皮肤老化过程中起着重要的作用。     

Nd:YAG激光与强脉冲光非剥脱性嫩肤的动物实验

Objective To observe the histological change of different waves in treating SD rats of the long-pulse 1064nm Nd:YAG laser and the 560～1200 nm intense pulse light,in order to provide the theory bases of non-ablative rejuvenation.Methods Two waves were used on experimental mice.The dermic thickness and the expression of collagen typesⅠand Ⅲwere detected by HE stain and immunohistochemical methods. Semiquantitative analysis was used to determine the mean of absorbance.Results Thedermal thicknesses and the mean of absorbance of collagen typesⅠandⅢin two different waves were higher than those in common control groups(P＜0.05).The effect of Nd:YAG laser groups were higher than IPL groups(P＜0.05).The expression of collagen typeⅠwas higher than that of collagen type Ⅲ(P＜0.001).Conclusion After Nd:YAG laser or IPL irradiation,the dermal thickness and collagen typesⅠandⅢof SD rats are increased.The effects of Nd:YAG laser are better than those of 560～1 200 nm IPL.The expression of collagen type Ⅲ is obviously more than that of collagen typeⅠin the early,whereas the expression of collagen typeⅠis obviously more than that of collagen type Ⅲin the later.It proves that the mechanism of dermal remodeling of non-ablative skin rejuvenation is mainly correlation with raising range and time of collagen typeⅠ.     

Nd：YAG激光与强脉冲光非剥脱性嫩肤的动物实验

目的探讨Nd：YAG激光长脉宽波长1064nm与强脉冲光（intense pulsed light,IPL）波长560～1200nm两种波长照射SD大鼠皮肤后组织学变化趋势,为临床非剥脱性光嫩肤的科学治疗提供理论依据。方法应用两种波长照射SD大鼠背部脱毛皮肤,通过HE染色和免疫组织化学染色方法检测真皮厚度、Ⅰ型和Ⅲ型胶原蛋白的表达,并测定平均吸光度值进行半定量分析。结果两种波长照射后真皮厚度、Ⅰ型及Ⅲ型胶原蛋白平均吸光度值均高于正常对照组（P〈0．05）,激光组均又高于IPL组（P〈O．05）,Ⅰ型胶原蛋白平均吸光度增加值均高于Ⅲ型胶原蛋白（P〈0．001）。结论两种波长均可使SD大鼠真皮厚度和Ⅰ型、Ⅲ型胶原蛋白增加,激光组优于IPL组。Ⅲ型胶原蛋白在照射早期增加幅度较高,而Ⅰ型胶原蛋白在照射后期增加幅度较高,提示非剥脱性光嫩肤真皮重塑机制可能与Ⅰ型胶原蛋白增加的时间和量有关。     

光子嫩肤仪配合激光治疗皮肤光老化疗效的观察

目的 探讨光子嫩肤仪配合755nm激光治疗皮肤光老化的疗效。方法 根据皮肤光老化者的肤质及疗效调节治疗方案，光子及激光交替进行治疗，每例治疗5次或5次以上。在治疗前和完成疗程后，由主治医师和接受治疗者共同对疗效做出评价。结果 本组178例，经治疗皮肤光老化症状均有不同程度改善，其中以肤色、毛细血管扩张、皮肤质地改善最为明显。临床观察表明，只要选择合适参数及完成疗程，治疗效果明显。结论 光子嫩肤仪配合755nm激光治疗皮肤光老化，是改善光老化表现的有效方法，并且比其他有损伤性治疗发生的合并症少，安全有效。     

强脉冲光治疗面部寻常型痤疮

目的：观察强脉冲光治疗面部寻常型痤疮的疗效.方法：应用光子痤疮治疗仪治疗31例面部寻常型痤疮患者,病情Ⅱ～Ⅲ级（炎性和非炎性皮损总数分别为31～50个和51～100个）,治疗波长415nm,每周2次,治疗4～6周,观察记录临床反应,每周拍摄皮损图像.结果：31例患者总有效率61%,皮脂溢出减少率55.7%.治疗期间,未发现刺激、皮炎等不良反应.结论：强脉冲光（415nm）照射治疗痤疮疗效较好,疗程较短,治疗过程安全,可以作为治疗Ⅱ～Ⅲ级炎性痤疮的有效方法,尤其对于不能耐受内服或外用药物治疗者提供了一种安全有效的治疗方法。     

Combined use of intense pulsed light and Q-switched ruby laser for complex dyspigmentation among Asian patients

BACKGROUND: Dyspigmentation is a common cosmetic concern among Asians. Many individuals exhibit mixed pigmentary entities including melasma, flat/small seborrheic keratoses, ephelides, solar lentigines and acquired bilateral nevus-of-Ota-like macules (ABNOM). We term this phenomenon complex dyspigmentation (CD) and suggest that a combination strategy may be more efficacious than any singular modality. OBJECTIVE: To determine the effectiveness of combined intense-pulsed light (IPL) for global photorejuvenation along with Q-switched ruby laser (QSRL) for targeted pigment dissolution. STUDY DESIGN/MATERIALS AND METHODS: Twenty-five Korean women with CD (defined as >2 types of facial pigmentary disorders) were initially treated with IPL followed by repeat treatments every 3-4 weeks as needed. The QSRL treatments, set at low fluence, were added either during the same session or within 1 week of the IPL treatment. Improvement was assessed by the patient, the treating physician and a blinded evaluation of pre- and post-treatment photographs. RESULTS: Using a 4-point scale (1 = poor, 2 = fair, 3 = good, 4 = excellent), 19/25 patients (76%) reporting good-to-excellent response (score "3" or "4"). Two independent physician assessment revealed that 15/25 patients (60%) showed 76-100% improvement while 19/25 patients (76%) showed at least 50% improvement. Side-effects were minimal: 3 patients had transient post-inflammatory hyperpigmentation (12%) and 1 patient (4%) had linear hypopigmentation. CONCLUSIONS: Combination treatment with IPL and QSRL is an effective and safe treatment for CD among Asian patients.